# STONECREEK SURGERY CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417114166
- **Authorized official:** AMY GRIM (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (702) 202-4776

## Contact information

- **Practice address:** 5915 S RAINBOW BLVD STE 108, LAS VEGAS, NV 89118-2558
- **Practice address phone:** (702) 227-7959
- **Practice address fax:** (702) 227-6344
- **Mailing address:** 2850 W HORIZON RIDGE PKWY STE 300, HENDERSON, NV 89052-4395
- **Mailing address phone:** (702) 202-4776

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/20/2008
- **Last updated:** 03/11/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1417114166 | — | NV |