Provider Demographics
NPI:1134290893
Name:TCS SURGICAL FACILITY, PC
Entity Type:Organization
Organization Name:TCS SURGICAL FACILITY, PC
Other - Org Name:TCS SURGICAL FACILITY, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:SAMUAL
Authorized Official - Last Name:TRAIKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:623-516-1030
Mailing Address - Street 1:19636 N 27TH AVE
Mailing Address - Street 2:STE 206
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4013
Mailing Address - Country:US
Mailing Address - Phone:623-516-1030
Mailing Address - Fax:623-580-9084
Practice Address - Street 1:19636 N 27TH AVE
Practice Address - Street 2:STE 206
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4013
Practice Address - Country:US
Practice Address - Phone:623-516-1030
Practice Address - Fax:623-580-9084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ394718261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZIZ1004OtherHEALTHNET PROVIDER