Provider Demographics
NPI:1073155834
Name:REGENCY AMBULATORY SURGERY CENTER ONE, LLC
Entity Type:Organization
Organization Name:REGENCY AMBULATORY SURGERY CENTER ONE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MUSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-243-9077
Mailing Address - Street 1:10240 W INDIAN SCHOOL RD STE 115
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-5905
Mailing Address - Country:US
Mailing Address - Phone:623-243-9077
Mailing Address - Fax:623-271-9826
Practice Address - Street 1:14725 W MOUNTAIN VIEW BLVD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2704
Practice Address - Country:US
Practice Address - Phone:623-243-9077
Practice Address - Fax:623-271-9826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-14
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical