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NPI Code Detail

MEDICARE: STONECREEK SURGERY CENTER LLC

MEDICARE: STONECREEK 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
1261QA1903XAmbulatory Surgical Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417114166
Entity Type Code : Organization
Provider Name (Legal Business Name) : STONECREEK SURGERY CENTER LLC
Provider Business Mailing Address
First Line : 2850 W HORIZON RIDGE PKWY STE 300
Second Line :
City : HENDERSON
State : NV
Zip : 89052-4395
Country : US
Telephone Number : 702-202-4776
Fax Number :
Provider Business Practice Location Address
First Line : 5915 S RAINBOW BLVD STE 108
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118-2558
Country : US
Telephone Number : 702-227-7959
Fax Number : 702-227-6344
Authorized Official
Title or Position : CREDENTIALING SPECIALIST
Name : AMY GRIM
Credential :
Telephone Number : 702-202-4776
Provider Enumeration Date : 05/20/2008
Last Update Date : 03/11/2022

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Directions to “STONECREEK SURGERY CENTER LLC ” Practice Location

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