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General NPI Number Information
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NPI Number | 1801908843
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Entity Type | Organization
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Legal Business Name | DESERT SHADOW ENDOCOPY CENTER, LLC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 06/27/2008
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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 | 702-220-5601
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Fax | 702-227-3076
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Provider Business Mailing Address
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Address Line | PO BOX 35140
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City | LAS VEGAS
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State | NV
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Zip | 89133-5140
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Country | US
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Telephone | 702-220-5601
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Fax | 702-227-3076
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Authorized Official
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Title or Position | DIRECTOR
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Name | DIPAK DESAI
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Credential | M.D.
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Telephone | 702-220-5601
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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 | 4493ASC-0
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License Number State | NV
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