Healthcare Provider Details

I. General information

NPI: 1992770820
Provider Name (Legal Business Name): SUNRISE TRAUMA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3186 S MARYLAND PKWY
LAS VEGAS NV
89109
US

IV. Provider business mailing address

3196 S MARYLAND PKWY SUITE 101
LAS VEGAS NV
89109
US

V. Phone/Fax

Practice location:
  • Phone: 702-731-8099
  • Fax: 702-731-8292
Mailing address:
  • Phone: 702-731-8099
  • Fax: 702-731-8292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number State

VIII. Authorized Official

Name: DAN PERRITT
Title or Position: CFO
Credential:
Phone: 702-731-8012