Provider Demographics
NPI:1225263775
Name:SMOKE RANCH SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:SMOKE RANCH SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASWINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:GROVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-320-8111
Mailing Address - Street 1:7180 SMOKE RANCH RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128
Mailing Address - Country:US
Mailing Address - Phone:702-483-2270
Mailing Address - Fax:702-483-2279
Practice Address - Street 1:7180 SMOKE RANCH RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:702-483-2270
Practice Address - Fax:702-483-2279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
F1081Medicare PIN
NVF1081Medicare PIN