Provider Demographics
NPI:1013195569
Name:SUN CITY WEST SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:SUN CITY WEST SURGERY CENTER, LLC
Other - Org Name:DESERT MIRAGE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINICAL DEVELOPMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:FAY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-623-7743
Mailing Address - Street 1:12361 W BOLA DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-9019
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12361 W BOLA DR
Practice Address - Street 2:SUITE 112
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-9019
Practice Address - Country:US
Practice Address - Phone:405-285-7500
Practice Address - Fax:405-285-7501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical