Provider Demographics
NPI:1578980421
Name:SUNSET RIDGE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:SUNSET RIDGE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:W
Authorized Official - Last Name:TOLLESTRUP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-917-3333
Mailing Address - Street 1:8352 W WARM SPRINGS RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-3628
Mailing Address - Country:US
Mailing Address - Phone:702-445-6993
Mailing Address - Fax:702-445-7411
Practice Address - Street 1:8352 W WARM SPRINGS RD
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-3628
Practice Address - Country:US
Practice Address - Phone:702-445-6993
Practice Address - Fax:702-445-7411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2014-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical