Provider Demographics
NPI:1457813107
Name:SURGEON'S SURGERY CENTER SORELLE PLLC
Entity Type:Organization
Organization Name:SURGEON'S SURGERY CENTER SORELLE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SORELLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-339-4668
Mailing Address - Street 1:PO BOX 27874
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0874
Mailing Address - Country:US
Mailing Address - Phone:702-982-3555
Mailing Address - Fax:866-787-4371
Practice Address - Street 1:6940 S CIMARRON RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2135
Practice Address - Country:US
Practice Address - Phone:702-982-3555
Practice Address - Fax:866-787-4371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty