Provider Demographics
NPI:1063254084
Name:WALANT ASC LLC
Entity type:Organization
Organization Name:WALANT ASC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:JORDAN
Authorized Official - Last Name:MICEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-798-8585
Mailing Address - Street 1:8585 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2817
Mailing Address - Country:US
Mailing Address - Phone:702-798-8585
Mailing Address - Fax:
Practice Address - Street 1:8585 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2817
Practice Address - Country:US
Practice Address - Phone:702-798-8585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty