Healthcare Provider Details

I. General information

NPI: 1174716708
Provider Name (Legal Business Name): HENDERSON SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 WIGWAM PKWY SUITE 105
HENDERSON NV
89074-8185
US

IV. Provider business mailing address

1110 WIGWAM PKWY SUITE 105
HENDERSON NV
89074-8185
US

V. Phone/Fax

Practice location:
  • Phone: 702-921-6829
  • Fax: 702-921-6828
Mailing address:
  • Phone: 702-921-6829
  • Fax: 702-921-6828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number743038
License Number StateNV

VIII. Authorized Official

Name: RAJAT SOOD
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 702-921-6829