MEDICARE: PARKWAY 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	2147ASC	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	490004254	OTHER	NV	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	10-6133	OTHER	NV	CSHCN
3	NV1692	OTHER	NV	BCBS

General Provider Information

NPI Number	:	1366446189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKWAY SURGERY CENTER, LLC.

Provider Business Mailing Address
First Line	:	100 N GREEN VALLEY PKWY
Second Line	:	STE 125
City	:	HENDERSON
State	:	NV
Zip	:	89074-6392
Country	:	US
Telephone Number	:	702-616-4954
Fax Number	:	702-269-0436

Provider Business Practice Location Address
First Line	:	100 N GREEN VALLEY PKWY
Second Line	:	STE 125
City	:	HENDERSON
State	:	NV
Zip	:	89074-6392
Country	:	US
Telephone Number	:	702-616-4954
Fax Number	:	702-269-0436

Authorized Official
Title or Position	:	OFFICER / AUTHORIZED OFFICIAL
Name	:	ERIC BOON
Credential	:
Telephone Number	:	480-567-0269

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	09/17/2024

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Directions to “PARKWAY SURGERY CENTER, LLC. ” Practice Location

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