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General NPI Number Information
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NPI Number | 1790873966
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Entity Type | Organization
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Legal Business Name | FLAMINGO PECOS SURGERY LLC
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 05/11/2011
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Provider Practice Location Address
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Address Line | 4275 BURNHAM AVE SUITE 101
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City | LAS VEGAS
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State | NV
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Zip | 89119-5488
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Country | US
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Telephone | 702-933-8088
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Fax | 702-933-5040
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Provider Business Mailing Address
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Address Line | 2110 E FLAMINGO RD SUITE 109
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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 | 702-868-2796
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Fax | 702-650-5099
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ROBERT W. BARNES
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Credential |
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Telephone | 702-868-2796
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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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