Basic Information
| Provider Information | |||||||||
| NPI: | 1922345594 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PORTEOUS UNITED SURGICAL ANESTHESIOLOGISTS, PLLC | ||||||||
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| OtherOrganizationName: | SURGI-CLEAR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7326 W CHEYENNE AVE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891296201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023864700 | ||||||||
| FaxNumber: | 7023864701 | ||||||||
| Practice Location | |||||||||
| Address1: | 2739 SUNRIDGE HEIGHTS PKWY | ||||||||
| Address2: | STE 110 | ||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890525042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023864700 | ||||||||
| FaxNumber: | 7023864701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2013 | ||||||||
| LastUpdateDate: | 01/15/2013 | ||||||||
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| AuthorizedOfficialLastName: | PORTEOUS | ||||||||
| AuthorizedOfficialFirstName: | GREGSON | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7023864700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.