MEDICARE: VEGAS SURGERY CENTER, 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

General Provider Information

NPI Number	:	1225590631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VEGAS SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	9111 W RUSSELL RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1245
Country	:	US
Telephone Number	:	702-312-3333
Fax Number	:	702-312-1144

Provider Business Practice Location Address
First Line	:	9111 W RUSSELL RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1245
Country	:	US
Telephone Number	:	702-312-3333
Fax Number	:	702-312-1144

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	ELLEN LOVAN
Credential	:
Telephone Number	:	702-312-3333

Provider Enumeration Date	:	04/03/2019
Last Update Date	:	04/03/2019

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