Healthcare Provider Details

I. General information

NPI: 1164316790
Provider Name (Legal Business Name): ELKHORN SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7175 N DURANGO DR STE 100
LAS VEGAS NV
89149-4479
US

IV. Provider business mailing address

6761 PEACH PIE AVE
LAS VEGAS NV
89131-3702
US

V. Phone/Fax

Practice location:
  • Phone: 702-342-8002
  • Fax:
Mailing address:
  • Phone: 702-917-3497
  • Fax:

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. PAUL QUAYLE REYNOLDS
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 702-917-3497