MEDICARE: EAR NOSE THROAT 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	208600000X	Surgery Physician
2	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1679277032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAR NOSE THROAT SURGERY CENTER

Provider Business Mailing Address
First Line	:	8840 W SUNSET RD STE B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-4897
Country	:	US
Telephone Number	:	702-209-3377
Fax Number	:	702-209-3369

Provider Business Practice Location Address
First Line	:	8840 W SUNSET RD STE B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-4897
Country	:	US
Telephone Number	:	702-209-3377
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	LAURA C MADRID
Credential	:
Telephone Number	:	702-209-3377

Provider Enumeration Date	:	03/29/2023
Last Update Date	:	03/29/2023

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