Provider Demographics
NPI:1306441670
Name:MOUNTAIN WEST SURGERY CENTER LLC
Entity type:Organization
Organization Name:MOUNTAIN WEST SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRATISLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:VELIMIROVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-532-2222
Mailing Address - Street 1:6204 CONSTELLATION DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3304
Mailing Address - Country:US
Mailing Address - Phone:917-549-7710
Mailing Address - Fax:
Practice Address - Street 1:3909 N MESA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1501
Practice Address - Country:US
Practice Address - Phone:214-417-9650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical