MEDICARE: SPECIALTY ASC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	3406ASC-8	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	29C0001049	OTHER	NV	MEDICARE DMERC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083669196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALTY ASC LLC

Provider Business Mailing Address
First Line	:	9499 W CHARLESTON BLVD
Second Line	:	SUITE 250
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7147
Country	:	US
Telephone Number	:	702-933-3600
Fax Number	:	702-933-3601

Provider Business Practice Location Address
First Line	:	9499 W CHARLESTON BLVD
Second Line	:	SUITE 250
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7147
Country	:	US
Telephone Number	:	702-933-3600
Fax Number	:	702-933-3601

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MICHELLE BENNION
Credential	:
Telephone Number	:	702-933-3600

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	03/03/2010

Similar Medicare Providers

1902807613 — STEVEN C THOMAS MD
Practice Location Address:

9499 W CHARLESTON BLVD , STE 200
LAS VEGAS, NV
89117-7147

Practice Phone: 702-933-9393
Practice Fax: 702-933-6789

1437151917 — ROBERT CLINTON HAYES MD
Practice Location Address:

9499 W CHARLESTON BLVD STE 150
LAS VEGAS, NV
89117-7147

Practice Phone: 775-727-5509
Practice Fax: 775-727-5696

1265419014 — ORTHOPEDICS & SPORTS MEDICINE LLC
Practice Location Address:

9499 W CHARLESTON BLVD , STE 200
LAS VEGAS, NV
89117-7147

Practice Phone: 702-933-9393
Practice Fax: 702-933-6789

1770551426 — RUSSELL KEVIN BOULDIN R.P.T
Practice Location Address:

9499 W CHARLESTON BLVD , SUITE 220
LAS VEGAS, NV
89117-7147

Practice Phone: 702-933-9394
Practice Fax: 702-933-9395

1720038185 — SUNEETHA CHINTA M.D.
Practice Location Address:

9499 W CHARLESTON BLVD STE 150
LAS VEGAS, NV
89117-7147

Practice Phone: 702-228-5477
Practice Fax: 702-255-7981

1538112792 — DR. DONALD W. PENNINGTON D.O.
Practice Location Address:

9499 W CHARLESTON BLVD STE 200
LAS VEGAS, NV
89117-7147

Practice Phone: 29-339-3937
Practice Fax: 702-933-6789

Directions to “SPECIALTY ASC LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.