Healthcare Provider Details

I. General information

NPI: 1235779752
Provider Name (Legal Business Name): GRANITE SAHARA SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
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: 702-254-1777
  • Fax: 702-254-1213
Mailing address:
  • Phone: 702-254-1777
  • Fax: 702-254-1213

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: SHELLEY SCHULTE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 702-254-1777