Provider Demographics
NPI:1922332774
Name:PREMIUM SURGICAL SERVICES CENTER
Entity Type:Organization
Organization Name:PREMIUM SURGICAL SERVICES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:L
Authorized Official - Last Name:STILE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-243-9555
Mailing Address - Street 1:8954 SPANISH RIDGE AVE SUITE 2
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148
Mailing Address - Country:US
Mailing Address - Phone:702-221-9374
Mailing Address - Fax:702-221-9805
Practice Address - Street 1:8954 SPANISH RIDGE AVENUE SUITE 1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148
Practice Address - Country:US
Practice Address - Phone:702-243-9555
Practice Address - Fax:702-243-9856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-28
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV200969825261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical