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General NPI Number Information
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NPI Number | 1588053300
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Entity Type | Organization
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Legal Business Name | ONSYTE SURGICAL OF NEVADA, LLC
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Dates
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Enumeration Date | 01/16/2015
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Last Update Date | 01/16/2015
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Provider Practice Location Address
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Address Line | 1262 S 650 W SUITE 1D
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City | FARMINGTON
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State | UT
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Zip | 84025
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Country | US
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Telephone | 844-466-7983
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Fax | 844-332-5038
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Provider Business Mailing Address
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Address Line | 1262 S 650 W STE 1D
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City | FARMINGTON
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State | UT
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Zip | 84025-4606
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Country | US
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Telephone | 844-466-7983
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Fax | 844-332-5038
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | DR. ROBERT R BLOCKER
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Credential | M.D.
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Telephone | 801-564-3368
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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 | NV20141489275
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License Number State | NV
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