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General NPI Number Information
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NPI Number | 1083669196
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Entity Type | Organization
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Legal Business Name | SPECIALTY ASC LLC
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 03/03/2010
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Provider Practice Location Address
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Address Line | 9499 W CHARLESTON BLVD SUITE 250
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City | LAS VEGAS
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State | NV
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Zip | 89117-7147
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Country | US
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Telephone | 702-933-3600
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Fax | 702-933-3601
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Provider Business Mailing Address
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Address Line | 9499 W CHARLESTON BLVD SUITE 250
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City | LAS VEGAS
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State | NV
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Zip | 89117-7147
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Country | US
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Telephone | 702-933-3600
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Fax | 702-933-3601
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MICHELLE BENNION
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Credential |
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Telephone | 702-933-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 3406ASC-8
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License Number State | NV
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