Provider Demographics
NPI:1104883248
Name:SURGICAL CENTER AT TENAYA LP
Entity type:Organization
Organization Name:SURGICAL CENTER AT TENAYA LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHARFF
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:205-545-2572
Mailing Address - Street 1:2650 N TENAYA WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-1102
Mailing Address - Country:US
Mailing Address - Phone:705-952-3610
Mailing Address - Fax:
Practice Address - Street 1:2650 N TENAYA WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1102
Practice Address - Country:US
Practice Address - Phone:705-952-3610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3167ASC-6261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV34562Medicare PIN