Healthcare Provider Details

I. General information

NPI: 1467793182
Provider Name (Legal Business Name): GRANITE SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 W SAHARA AVE STE 100
LAS VEGAS NV
89117-5865
US

IV. Provider business mailing address

8851 W SAHARA AVE STE 100
LAS VEGAS NV
89117-5865
US

V. Phone/Fax

Practice location:
  • Phone: 702-254-1197
  • Fax: 702-228-2678
Mailing address:
  • Phone: 702-254-1197
  • Fax: 702-228-2678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0006X
TaxonomyAmbulatory Fertility Facility
License Number5710
License Number StateNV

VIII. Authorized Official

Name: DR. BRUCE SHAPIRO
Title or Position: PARTNER
Credential: MD PHD
Phone: 702-254-1197