MEDICARE: 215 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

General Provider Information

NPI Number	:	1629492137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	215 SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	6120 S FORT APACHE RD
Second Line	:	STE. 200
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-6702
Country	:	US
Telephone Number	:	702-948-8894
Fax Number	:	702-948-8956

Provider Business Practice Location Address
First Line	:	6120 S FORT APACHE RD
Second Line	:	STE. 200
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-6702
Country	:	US
Telephone Number	:	702-948-8894
Fax Number	:	702-948-8956

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HEATH WILLS
Credential	:	MD
Telephone Number	:	702-449-1912

Provider Enumeration Date	:	02/05/2014
Last Update Date	:	07/04/2014

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