Provider Demographics
NPI:1023420759
Name:WOMEN'S CANCER CENTER DIVISION OF COLORECTAL SURGERY
Entity type:Organization
Organization Name:WOMEN'S CANCER CENTER DIVISION OF COLORECTAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-693-6870
Mailing Address - Street 1:3131 LA CANADA ST STE 241
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-2588
Mailing Address - Country:US
Mailing Address - Phone:702-326-0585
Mailing Address - Fax:702-835-0041
Practice Address - Street 1:3131 LA CANADA ST STE 241
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-2588
Practice Address - Country:US
Practice Address - Phone:702-326-0585
Practice Address - Fax:702-835-0041
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOMENS CANCER CENTER OF NV
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty