Basic Information
| Provider Information | |||||||||
| NPI: | 1174716708 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HENDERSON SURGERY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1110 WIGWAM PKWY | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890748185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029216829 | ||||||||
| FaxNumber: | 7029216828 | ||||||||
| Practice Location | |||||||||
| Address1: | 1110 WIGWAM PKWY | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890748185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029216829 | ||||||||
| FaxNumber: | 7029216828 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2007 | ||||||||
| LastUpdateDate: | 01/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | SOOD | ||||||||
| AuthorizedOfficialFirstName: | RAJAT | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 7029216829 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 743038 | NV | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.