Provider Demographics
NPI:1033642780
Name:QOL SURGERY CENTER LLC
Entity Type:Organization
Organization Name:QOL SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCGETTIGAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:520-495-5169
Mailing Address - Street 1:5350 E ERICKSON DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2822
Mailing Address - Country:US
Mailing Address - Phone:520-733-2250
Mailing Address - Fax:520-733-2270
Practice Address - Street 1:5350 E ERICKSON DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2822
Practice Address - Country:US
Practice Address - Phone:520-733-2250
Practice Address - Fax:520-733-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12606261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD44240Medicare UPIN