| Organization Name: | SPECIALTY ASC LLC |
| NPI Number: | 1003064890 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHELLE BENNION (ADMINISTRATOR) |
| Mailing Address: | 9499 W Charleston Blvd Ste 250 Las Vegas |
| State: | NV US |
| Postal Code: | 891177148 |
| Phone Number: | 7029333600 |
| Fax Number: | 7029333601 |
| NPI Enumeration Date: | 09/04/2008 |
| NPI Last Update Date: | 10/10/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | 3406ASC-8 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NV |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |