Provider Demographics
NPI:1386749943
Name:QUAIL SURGICAL AND PAIN MANAGEMENT CENTER, LLC
Entity type:Organization
Organization Name:QUAIL SURGICAL AND PAIN MANAGEMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-768-3300
Mailing Address - Street 1:6630 S MCCARRAN BLVD # C25
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6135
Mailing Address - Country:US
Mailing Address - Phone:775-827-7555
Mailing Address - Fax:
Practice Address - Street 1:6630 S MCCARRAN BLVD # C25
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6135
Practice Address - Country:US
Practice Address - Phone:775-827-7555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2337ASC-7261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV004616100Medicaid
NVV31666OtherMEDICARE ID-PIN
NVV31666Medicare PIN
NV004616100Medicaid