MEDICARE: TENAYA 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
1	261QA1903X	Ambulatory Surgical Clinic/Center	3011ASC-8	NV

General Provider Information

NPI Number	:	1538159728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENAYA SURGICAL CENTER, LLC

Provider Business Mailing Address
First Line	:	2800 N TENAYA WAY
Second Line	:	SUITE 101
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0652
Country	:	US
Telephone Number	:	702-838-7755
Fax Number	:	702-966-7766

Provider Business Practice Location Address
First Line	:	2800 N TENAYA WAY
Second Line	:	SUITE 101
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0652
Country	:	US
Telephone Number	:	702-838-7755
Fax Number	:	702-966-7766

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. TYREE CARR
Credential	:	MD
Telephone Number	:	702-838-7755

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	08/22/2020

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