1073705992 NPI number — LAS VEGAS REGIONAL SURGERY CENTER, LP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073705992 NPI number — LAS VEGAS REGIONAL SURGERY CENTER, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAS VEGAS REGIONAL SURGERY CENTER, LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073705992
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4333 ADMIRALTY WAY
Provider Second Line Business Mailing Address:
WEST HELIX #9
Provider Business Mailing Address City Name:
MARINA DEL REY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90292-5469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-301-8329
Provider Business Mailing Address Fax Number:
310-301-8329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3560 E FLAMINGO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89121-5044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-454-8712
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VERBUKH
Authorized Official First Name:
ISSAC
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
310-301-8329

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  468ASC-15 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)