Provider Demographics
NPI:1447310651
Name:THE SPARKS NV ENDOSCOPY ASC LLC
Entity type:Organization
Organization Name:THE SPARKS NV ENDOSCOPY ASC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER OF LLC
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:1525 LOS ALTOS PARKWAY
Mailing Address - Street 2:SPANISH SPRINGS
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1525 LOS ALTOS PARKWAY
Practice Address - Street 2:SPANISH SPRINGS
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436
Practice Address - Country:US
Practice Address - Phone:615-240-3850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical