Healthcare Provider Details

I. General information

NPI: 1699694190
Provider Name (Legal Business Name): PAINTED MIRAGE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 PAINTED MIRAGE RD STE 115
LAS VEGAS NV
89149-4581
US

IV. Provider business mailing address

5550 PAINTED MIRAGE RD STE 115
LAS VEGAS NV
89149-4581
US

V. Phone/Fax

Practice location:
  • Phone: 702-456-0025
  • Fax: 702-456-0025
Mailing address:
  • Phone: 702-456-0025
  • Fax: 702-456-0025

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: AMANDA DEAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 702-456-0025