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NPI Code Detail

MEDICARE: CENTENNIAL SURGICAL CENTER, LLC

MEDICARE: CENTENNIAL SURGICAL 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/Center3563ASC-6NV

General Provider Information

NPI Number : 1427245257
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTENNIAL SURGICAL CENTER, LLC
Provider Business Mailing Address
First Line : 4454 N DECATUR BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-5286
Country : US
Telephone Number : 702-839-1203
Fax Number : 702-839-1301
Provider Business Practice Location Address
First Line : 4454 N DECATUR BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-5286
Country : US
Telephone Number : 702-839-1203
Fax Number : 702-839-1301
Authorized Official
Title or Position : CEO
Name : DR. DAVID ROY LANZKOWSKY
Credential : M. D.
Telephone Number : 702-839-1203
Provider Enumeration Date : 09/25/2007
Last Update Date : 10/31/2007

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Directions to “CENTENNIAL SURGICAL CENTER, LLC ” Practice Location

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