Provider Demographics
NPI:1750827580
Name:PLATINUM SURGICAL ASSISTANTS OF LAS VEGAS
Entity Type:Organization
Organization Name:PLATINUM SURGICAL ASSISTANTS OF LAS VEGAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VERN
Authorized Official - Middle Name:VONTRICE
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:702-325-8928
Mailing Address - Street 1:4140 INGLEWOOD POINT ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-1147
Mailing Address - Country:US
Mailing Address - Phone:702-325-8928
Mailing Address - Fax:
Practice Address - Street 1:4140 INGLEWOOD POINT ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-1147
Practice Address - Country:US
Practice Address - Phone:702-325-8928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
126800000X, 363AS0400X
NV171630156FX1101X, 246ZC0007X, 246ZS0410X, 246ZX2200X
171630246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty
No156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic AssistantGroup - Multi-Specialty
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Multi-Specialty
No246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic AssistantGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty