Provider Demographics
NPI:1043095557
Name:GREENWAYSURGERY CENTER LLC
Entity Type:Organization
Organization Name:GREENWAYSURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLO/COO
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKER
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:480-573-0212
Mailing Address - Street 1:2525 W GREENWAY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-4292
Mailing Address - Country:US
Mailing Address - Phone:480-716-9991
Mailing Address - Fax:
Practice Address - Street 1:2525 W GREENWAY RD STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-4280
Practice Address - Country:US
Practice Address - Phone:480-716-9991
Practice Address - Fax:480-716-9991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical