Provider Demographics
NPI:1578749917
Name:SCDI SURGERY CENTER
Entity Type:Organization
Organization Name:SCDI SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRET
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKHART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-324-0699
Mailing Address - Street 1:640 W MOANA LN STE 2
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4857
Mailing Address - Country:US
Mailing Address - Phone:775-324-0699
Mailing Address - Fax:775-323-6814
Practice Address - Street 1:3950 G S RICHARDS BLVD
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703
Practice Address - Country:US
Practice Address - Phone:775-882-8777
Practice Address - Fax:775-888-8062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPENDING261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical