Provider Demographics
NPI:1679277032
Name:EAR NOSE THROAT SURGERY CENTER
Entity type:Organization
Organization Name:EAR NOSE THROAT SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MADRID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-209-3377
Mailing Address - Street 1:8840 W SUNSET RD STE B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4897
Mailing Address - Country:US
Mailing Address - Phone:702-209-3377
Mailing Address - Fax:702-209-3369
Practice Address - Street 1:8840 W SUNSET RD STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4897
Practice Address - Country:US
Practice Address - Phone:702-209-3377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty