Provider Demographics
NPI:1164012142
Name:COMPREHENSIVE DIGESTIVE SURGICENTER, LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE DIGESTIVE SURGICENTER, LLC
Other - Org Name:COMPREHENSIVE DIGESTIVE SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:SWINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-789-2877
Mailing Address - Street 1:8440 W WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-3624
Mailing Address - Country:US
Mailing Address - Phone:702-970-2383
Mailing Address - Fax:
Practice Address - Street 1:8440 W WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-3624
Practice Address - Country:US
Practice Address - Phone:702-970-2383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-22
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical