| Organization Name: | WILDCREEK SURGERY CENTER |
| NPI Number: | 1003875873 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DOUGLAS K. DEVRIES (OWNER) |
| Mailing Address: | 2285 Green Vista Dr Sparks |
| State: | NV US |
| Postal Code: | 894318532 |
| Phone Number: | 7756741110 |
| Fax Number: | 7756741114 |
| NPI Enumeration Date: | 03/21/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | 1830ASC-8 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NV |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |