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General NPI Number Information
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NPI Number | 1306441670
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Entity Type | Organization
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Legal Business Name | MOUNTAIN WEST SURGERY CENTER LLC
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Dates
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Enumeration Date | 12/03/2020
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Last Update Date | 07/17/2024
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Provider Practice Location Address
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Address Line | 3909 N MESA ST
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City | EL PASO
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State | TX
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Zip | 79902-1501
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Country | US
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Telephone | 214-417-9650
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Fax |
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Provider Business Mailing Address
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Address Line | 6204 CONSTELLATION DR
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City | EL PASO
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State | TX
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Zip | 79912-3304
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Country | US
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Telephone | 917-549-7710
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. BRATISLAV VELIMIROVIC
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Credential |
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Telephone | 915-532-2222
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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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