MEDICARE: WEST LAS VEGAS 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669585964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST LAS VEGAS SURGERY CENTER,LLC

Provider Business Mailing Address
First Line	:	1330 S VALLEY VIEW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1865
Country	:	US
Telephone Number	:	702-675-4600
Fax Number	:	702-675-4604

Provider Business Practice Location Address
First Line	:	1330 S VALLEY VIEW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1865
Country	:	US
Telephone Number	:	702-675-4600
Fax Number	:	702-675-4604

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	FAY DELA CRUZ
Credential	:	R.N.
Telephone Number	:	702-675-4600

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	02/22/2019

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