Provider Demographics
NPI:1821418807
Name:SCCN LLC
Entity Type:Organization
Organization Name:SCCN LLC
Other - Org Name:SYNERGY CANCER CENTER OF NEVADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING/COMPLIANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:SPANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-366-9740
Mailing Address - Street 1:3150 N TENAYA WAY
Mailing Address - Street 2:SUITE 510
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0443
Mailing Address - Country:US
Mailing Address - Phone:702-800-5055
Mailing Address - Fax:702-425-9794
Practice Address - Street 1:3150 N TENAYA WAY
Practice Address - Street 2:SUITE 510
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0443
Practice Address - Country:US
Practice Address - Phone:702-800-5055
Practice Address - Fax:702-425-9794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty