Provider Demographics
NPI: | 1073845087 |
---|---|
Name: | EYE SURGERY CENTERS OF ARIZONA, LLC |
Entity Type: | Organization |
Organization Name: | EYE SURGERY CENTERS OF ARIZONA, LLC |
Other - Org Name: | EYE SURGERY AT THE BILTMORE, LLC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | PHILLIP |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CLENDENIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 615-665-1283 |
Mailing Address - Street 1: | 1A BURTON HILLS BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | NASHVILLE |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37215-6187 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 615-665-1283 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2222 E HIGHLAND AVE STE 101 |
Practice Address - Street 2: | |
Practice Address - City: | PHOENIX |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85016-4874 |
Practice Address - Country: | US |
Practice Address - Phone: | 602-279-2434 |
Practice Address - Fax: | 602-279-6475 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-02-02 |
Last Update Date: | 2020-04-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QA1903X | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |