Provider Demographics
NPI:1003064890
Name:SPECIALTY ASC LLC
Entity Type:Organization
Organization Name:SPECIALTY ASC LLC
Other - Org Name:SURGICAL ARTS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-933-3600
Mailing Address - Street 1:9499 W CHARLESTON BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7148
Mailing Address - Country:US
Mailing Address - Phone:702-933-3600
Mailing Address - Fax:702-933-3601
Practice Address - Street 1:9499 W CHARLESTON BLVD STE 250
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7148
Practice Address - Country:US
Practice Address - Phone:702-933-3600
Practice Address - Fax:702-933-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3406ASC-8261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV29C0001049OtherMEDICARE DMERC
NV4602060Medicaid
NV4503950003Medicare NSC
NVV36164Medicare PIN