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General NPI Number Information
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NPI Number | 1780678383
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Entity Type | Organization
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Legal Business Name | ENDOSCOPY CENTER OF SOUTHERN NEVADA, LLC
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 700 SHADOW LN SUITE #165A
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City | LAS VEGAS
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State | NV
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Zip | 89106-4126
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Country | US
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Telephone | 702-380-0809
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Fax | 702-382-4641
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Provider Business Mailing Address
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Address Line | 700 SHADOW LN SUITE #165B
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City | LAS VEGAS
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State | NV
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Zip | 89106-4126
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Country | US
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Telephone | 702-380-0809
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Fax | 702-382-4641
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Authorized Official
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Title or Position | PRESIDENT/MEMBER
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Name | DR. DIPAK DESAI
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Credential | M.D.
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Telephone | 702-382-8101
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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 | 472ASC9
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License Number State | NV
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