Provider Demographics
NPI:1477897296
Name:AMBULATORY ANESTHESIASPECIALISTS OF NEVADA LLC
Entity Type:Organization
Organization Name:AMBULATORY ANESTHESIASPECIALISTS OF NEVADA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-204-0099
Mailing Address - Street 1:2957 EL CAMINO ROAD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5224
Mailing Address - Country:US
Mailing Address - Phone:800-204-0099
Mailing Address - Fax:336-882-2216
Practice Address - Street 1:9280 W SUNSET
Practice Address - Street 2:#210
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4861
Practice Address - Country:US
Practice Address - Phone:800-204-0099
Practice Address - Fax:336-882-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty