MEDICARE: ASCENDIA MEDICAL GROUP 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1295697837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCENDIA MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	769 VISCANIO PL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-7570
Country	:	US
Telephone Number	:	770-701-9590
Fax Number	:	770-701-9590

Provider Business Practice Location Address
First Line	:	769 VISCANIO PL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-7570
Country	:	US
Telephone Number	:	770-701-9590
Fax Number	:	770-701-9590

Authorized Official
Title or Position	:	PARTNER
Name	:	TONY FECELLOW BESS
Credential	:
Telephone Number	:	770-701-9590

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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Directions to “ASCENDIA MEDICAL GROUP LLC ” Practice Location

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