Healthcare Provider Details

I. General information

NPI: 1629492137
Provider Name (Legal Business Name): 215 SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 07/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6120 S FORT APACHE RD STE. 200
LAS VEGAS NV
89148-6702
US

IV. Provider business mailing address

6120 S FORT APACHE RD STE. 200
LAS VEGAS NV
89148-6702
US

V. Phone/Fax

Practice location:
  • Phone: 702-948-8894
  • Fax: 702-948-8956
Mailing address:
  • Phone: 702-948-8894
  • Fax: 702-948-8956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. HEATH WILLS
Title or Position: OWNER
Credential: MD
Phone: 702-449-1912