=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962963728
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VISIONARY SURGERY CENTER OF NEVADA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2019
-----------------------------------------------------
Last Update Date | 10/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10463 DOUBLE R BLVD
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89521-5866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-562-2121
-----------------------------------------------------
Fax | 775-322-1050
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10463 DOUBLE R BLVD STE 200
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89521-8922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-562-2121
-----------------------------------------------------
Fax | 775-322-1050
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | ALLISON H WHITLOW
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 775-799-2200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------