Basic Information
| Provider Information | |||||||||
| NPI: | 1578749917 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SCDI SURGERY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 640 W MOANA LN STE 2 | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895094857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753240699 | ||||||||
| FaxNumber: | 7753236814 | ||||||||
| Practice Location | |||||||||
| Address1: | 3950 G S RICHARDS BLVD | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758828777 | ||||||||
| FaxNumber: | 7758888062 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2008 | ||||||||
| LastUpdateDate: | 01/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | BLACKHART | ||||||||
| AuthorizedOfficialFirstName: | BRET | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7753240699 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | PENDING | NV | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.