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General NPI Number Information
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NPI Number | 1306093604
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Entity Type | Organization
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Legal Business Name | BOX CANYON SURGERY CENTER LLC
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Dates
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Enumeration Date | 08/19/2008
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Last Update Date | 08/19/2008
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Provider Practice Location Address
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Address Line | 2555 BOX CANYON DR
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City | LAS VEGAS
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State | NV
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Zip | 89128
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Country | US
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Telephone | 702-733-2020
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Fax | 702-734-8748
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Provider Business Mailing Address
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Address Line | 2110 E FLAMINGO RD SUITE 210
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City | LAS VEGAS
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State | NV
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Zip | 89119-5190
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Country | US
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Telephone | 702-733-2020
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Fax | 702-734-8748
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENT L WELLISH
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Credential | M.D.
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Telephone | 702-733-2020
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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 |
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License Number State |
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