Provider Demographics
NPI:1700910585
Name:SPANISH HILLS SURGICAL CENTER LLC
Entity type:Organization
Organization Name:SPANISH HILLS SURGICAL CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-382-8101
Mailing Address - Street 1:700 SHADOW LN
Mailing Address - Street 2:SUITE #165A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4126
Mailing Address - Country:US
Mailing Address - Phone:702-382-8101
Mailing Address - Fax:702-382-4890
Practice Address - Street 1:5915 S RAINBOW BOULEVARD
Practice Address - Street 2:SUITE #106
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113
Practice Address - Country:US
Practice Address - Phone:702-382-8101
Practice Address - Fax:702-382-4890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPENDING ISSUE261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV685095OtherNV STATE BUSINESS LICENSE