Provider Demographics
NPI:1073579256
Name:OUTPATIENT SURGICAL CARE LTD
Entity Type:Organization
Organization Name:OUTPATIENT SURGICAL CARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-995-3395
Mailing Address - Street 1:1530 W GLENDALE AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-8578
Mailing Address - Country:US
Mailing Address - Phone:602-995-3395
Mailing Address - Fax:602-995-1853
Practice Address - Street 1:1530 W GLENDALE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-8578
Practice Address - Country:US
Practice Address - Phone:602-995-3395
Practice Address - Fax:602-995-1853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC0032261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ062232Medicaid
AZ062232Medicaid