Healthcare Provider Details

I. General information

NPI: 1780678383
Provider Name (Legal Business Name): ENDOSCOPY CENTER OF SOUTHERN NEVADA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SHADOW LN SUITE #165A
LAS VEGAS NV
89106-4126
US

IV. Provider business mailing address

700 SHADOW LN SUITE #165B
LAS VEGAS NV
89106-4126
US

V. Phone/Fax

Practice location:
  • Phone: 702-380-0809
  • Fax: 702-382-4641
Mailing address:
  • Phone: 702-380-0809
  • Fax: 702-382-4641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number472ASC9
License Number StateNV

VIII. Authorized Official

Name: DR. DIPAK DESAI
Title or Position: PRESIDENT/MEMBER
Credential: M.D.
Phone: 702-382-8101