Provider Demographics
NPI:1073709689
Name:NORTH MOUNTAIN SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:NORTH MOUNTAIN SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:NANCE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CNOR, CASC
Authorized Official - Phone:602-903-0360
Mailing Address - Street 1:PO BOX 47510
Mailing Address - Street 2:9250 N 3RD ST SUITE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85068-7510
Mailing Address - Country:US
Mailing Address - Phone:602-903-0360
Mailing Address - Fax:
Practice Address - Street 1:9250 N 3RD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020
Practice Address - Country:US
Practice Address - Phone:602-903-0360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical