Provider Demographics
NPI:1437331014
Name:NEVADA SURGICAL SPECIALISTS LLC
Entity type:Organization
Organization Name:NEVADA SURGICAL SPECIALISTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:DENNY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-254-3939
Mailing Address - Street 1:3570 E FLAMINGO ROAD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5000
Mailing Address - Country:US
Mailing Address - Phone:702-454-3400
Mailing Address - Fax:702-454-7185
Practice Address - Street 1:3570 E FLAMINGO ROAD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5000
Practice Address - Country:US
Practice Address - Phone:702-454-3400
Practice Address - Fax:702-454-7185
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEVADA SURGICAL SPECIALISTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-05
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2126174400000X
LA05906R174400000X
NVNV5503174400000X
NV5503207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002847Medicaid
NV01240039OtherAMERIGROUP
NV01240039OtherAMERIGROUP
NVV38886Medicare PIN
NV002002847Medicaid
NVB61781Medicare UPIN