Provider Demographics
NPI:1568752202
Name:WOODWARD AVE., LLC
Entity Type:Organization
Organization Name:WOODWARD AVE., LLC
Other - Org Name:DBA INNOVATIVE PROCEDURAL AND SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:PAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-316-2281
Mailing Address - Street 1:9920 W CHEYENNE AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7725
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9920 W CHEYENNE AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7725
Practice Address - Country:US
Practice Address - Phone:702-316-2281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical