Provider Demographics
NPI:1588053300
Name:ONSYTE SURGICAL OF NEVADA, LLC
Entity type:Organization
Organization Name:ONSYTE SURGICAL OF NEVADA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLOCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-564-3368
Mailing Address - Street 1:1262 S 650 W STE 1D
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-4606
Mailing Address - Country:US
Mailing Address - Phone:844-466-7983
Mailing Address - Fax:844-332-5038
Practice Address - Street 1:1262 S 650 W SUITE 1D
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025
Practice Address - Country:US
Practice Address - Phone:844-466-7983
Practice Address - Fax:844-332-5038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20141489275261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical