Provider Demographics
NPI:1164930491
Name:LVC SURGERY CENTER LLC
Entity Type:Organization
Organization Name:LVC SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING CONTACT
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OWYONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-802-3456
Mailing Address - Street 1:PO BOX 778210
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89077-8210
Mailing Address - Country:US
Mailing Address - Phone:702-802-3456
Mailing Address - Fax:702-802-3457
Practice Address - Street 1:1050 S RAINBOW BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-6231
Practice Address - Country:US
Practice Address - Phone:702-802-3456
Practice Address - Fax:702-802-3457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1164930491Medicaid