Provider Demographics
NPI:1154481984
Name:SPRING VALLEY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:SPRING VALLEY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GODWIN
Authorized Official - Middle Name:O
Authorized Official - Last Name:MADUKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHARMD
Authorized Official - Phone:702-880-4193
Mailing Address - Street 1:PO BOX 30550
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89173-0550
Mailing Address - Country:US
Mailing Address - Phone:702-227-4440
Mailing Address - Fax:702-227-4386
Practice Address - Street 1:3835 S. JONES BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-2283
Practice Address - Country:US
Practice Address - Phone:702-227-4440
Practice Address - Fax:702-227-4386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2000003 426261QA1903X
NVNV20011105262261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100500333Medicaid
NV37679Medicare ID - Type Unspecified
NVV37679Medicare PIN