Healthcare Provider Details

I. General information

NPI: 1710179940
Provider Name (Legal Business Name): GREEN VALLEY ANESTHESIA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2007
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3560 E FLAMINGO RD SUITE 105
LAS VEGAS NV
89121-5044
US

IV. Provider business mailing address

8845 ZURICH CT
LAS VEGAS NV
89147-8100
US

V. Phone/Fax

Practice location:
  • Phone: 702-454-8712
  • Fax:
Mailing address:
  • Phone:
  • 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: MR. GEORGE H COX
Title or Position: MANAGING PARTNER
Credential: CRNA
Phone: 702-227-3072