Provider Demographics
NPI:1689652638
Name:INSTITUTE OF ORTHOPAEDIC SURGERY LLC
Entity Type:Organization
Organization Name:INSTITUTE OF ORTHOPAEDIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PENDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-731-1616
Mailing Address - Street 1:PO BOX 92212
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-2212
Mailing Address - Country:US
Mailing Address - Phone:702-735-7355
Mailing Address - Fax:702-735-7966
Practice Address - Street 1:2800 E DESERT INN RD
Practice Address - Street 2:SUITE 150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3608
Practice Address - Country:US
Practice Address - Phone:702-735-7355
Practice Address - Fax:702-735-7966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3303ASC-7261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV004602200Medicaid
V38027OtherMEDICARE ID - TYPE UNSPECIFIED