MEDICARE: HENDERSON AMBULATORY SURGERY CENTER FOR MINIMALLY INVASIVE PROCEDURES

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	:	1659077956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENDERSON AMBULATORY SURGERY CENTER FOR MINIMALLY INVASIVE PROCEDURES

Provider Business Mailing Address
First Line	:	PO BOX 29650
Second Line	:	DEPT 880768
City	:	PHOENIX
State	:	AZ
Zip	:	85038-9650
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9120 W RUSSELL RD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1229
Country	:	US
Telephone Number	:	702-476-9700
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	NEVILLE F CAMPBELL
Credential	:
Telephone Number	:	347-886-4401

Provider Enumeration Date	:	02/07/2023
Last Update Date	:	02/09/2026

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