Provider Demographics
NPI:1073561049
Name:ARIZONA DIAGNOSTIC & SURGICAL CENTER, INC
Entity Type:Organization
Organization Name:ARIZONA DIAGNOSTIC & SURGICAL CENTER, INC
Other - Org Name:IASIS HEALTHCARE CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-844-6226
Mailing Address - Street 1:515 N MESA DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-5914
Mailing Address - Country:US
Mailing Address - Phone:480-969-9111
Mailing Address - Fax:480-969-0095
Practice Address - Street 1:515 N MESA DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-5914
Practice Address - Country:US
Practice Address - Phone:480-969-9111
Practice Address - Fax:480-969-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC0072261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ60968OtherBLUE CROSS PROVIDER NUMBE
AZ504440Medicaid
AZ504440Medicaid