Healthcare Provider Details

I. General information

NPI: 1689652638
Provider Name (Legal Business Name): INSTITUTE OF ORTHOPAEDIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E DESERT INN RD SUITE 150
LAS VEGAS NV
89121-3608
US

IV. Provider business mailing address

PO BOX 92212
LAS VEGAS NV
89193-2212
US

V. Phone/Fax

Practice location:
  • Phone: 702-735-7355
  • Fax: 702-735-7966
Mailing address:
  • Phone: 702-735-7355
  • Fax: 702-735-7966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number3303ASC-7
License Number StateNV

VIII. Authorized Official

Name: MR. MICHAEL PENDLETON
Title or Position: ADMINISTRATOR
Credential:
Phone: 702-731-1616