MEDICARE: RED ROCK PAIN SURGERY CENTER

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	:	1639527278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RED ROCK PAIN SURGERY CENTER

Provider Business Mailing Address
First Line	:	5915 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2557
Country	:	US
Telephone Number	:	702-778-6003
Fax Number	:	702-851-0392

Provider Business Practice Location Address
First Line	:	5915 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2557
Country	:	US
Telephone Number	:	702-778-6003
Fax Number	:	702-851-0392

Authorized Official
Title or Position	:	CLINICAL COORDINATOR
Name	:	MR. BILL SCHOONMAKER
Credential	:	RN
Telephone Number	:	702-778-6003

Provider Enumeration Date	:	05/24/2016
Last Update Date	:	05/24/2016

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Directions to “RED ROCK PAIN SURGERY CENTER ” Practice Location

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