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General NPI Number Information
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NPI Number | 1417114166
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Entity Type | Organization
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Legal Business Name | STONECREEK SURGERY CENTER LLC
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 03/11/2022
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Provider Practice Location Address
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Address Line | 5915 S RAINBOW BLVD STE 108
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City | LAS VEGAS
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State | NV
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Zip | 89118-2558
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Country | US
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Telephone | 702-227-7959
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Fax | 702-227-6344
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Provider Business Mailing Address
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Address Line | 2850 W HORIZON RIDGE PKWY STE 300
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City | HENDERSON
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State | NV
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Zip | 89052-4395
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Country | US
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Telephone | 702-202-4776
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | AMY GRIM
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Credential |
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Telephone | 702-202-4776
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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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