Provider Demographics
NPI:1770660706
Name:SAINT MARY'S OUTPATIENT SURGERY CENTER AT GALENA
Entity type:Organization
Organization Name:SAINT MARY'S OUTPATIENT SURGERY CENTER AT GALENA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP - COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:JASMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-770-6085
Mailing Address - Street 1:18653 WEDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-3005
Mailing Address - Country:US
Mailing Address - Phone:775-770-7218
Mailing Address - Fax:775-770-7228
Practice Address - Street 1:18653 WEDGE PKWY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-3005
Practice Address - Country:US
Practice Address - Phone:775-770-7218
Practice Address - Fax:775-770-7228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB0506616261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100500037Medicaid
490005759Medicare PIN
V37090Medicare PIN