Organization
SNNAC LLC
Active
Other names
Azura Surgery Center Northern Nevada
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES SULLIVAN III DO (AUTHORIZED OFFICIAL)
(775) 232-5387
Entity
Organization
Contact information
Practice address
932 RYLAND ST, RENO, NV 89502-1605
(775) 853-4166
Mailing address
40 VALLEY STREAM PKWY STE 100, MALVERN, PA 19355-1407
(610) 644-8900
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
250001294
—
NV
Enumeration date
11/17/2017
Last updated
04/27/2020
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