Provider Demographics
NPI:1962963728
Name:VISIONARY SURGERY CENTER OF NEVADA, LLC
Entity type:Organization
Organization Name:VISIONARY SURGERY CENTER OF NEVADA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-322-1000
Mailing Address - Street 1:PO BOX 19520
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-1979
Mailing Address - Country:US
Mailing Address - Phone:775-562-2121
Mailing Address - Fax:775-322-1050
Practice Address - Street 1:10463 DOUBLE R BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5866
Practice Address - Country:US
Practice Address - Phone:775-562-2121
Practice Address - Fax:775-322-1050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-26
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical