Provider Demographics
NPI:1962423178
Name:GENERAL SURGERY ASSOCIATES
Entity type:Organization
Organization Name:GENERAL SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-382-8222
Mailing Address - Street 1:5380 S RAINBOW BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-1880
Mailing Address - Country:US
Mailing Address - Phone:702-382-8222
Mailing Address - Fax:702-382-3935
Practice Address - Street 1:5380 S RAINBOW BLVD STE 330
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1880
Practice Address - Country:US
Practice Address - Phone:702-382-8222
Practice Address - Fax:702-382-3935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506621Medicaid
NVVWCHFLMedicare PIN