Healthcare Provider Details

I. General information

NPI: 1609862341
Provider Name (Legal Business Name): WESTERN NEVADA SURGICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 09/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 MOUNTAIN ST
CARSON CITY NV
89703-3816
US

IV. Provider business mailing address

1299 MOUNTAIN ST
CARSON CITY NV
89703-3816
US

V. Phone/Fax

Practice location:
  • Phone: 775-882-4477
  • Fax: 775-882-4479
Mailing address:
  • Phone: 775-882-4477
  • Fax: 775-882-4479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number4247ASC1
License Number StateNV

VIII. Authorized Official

Name: MEHDI VAZEEN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 775-882-4477