Provider Demographics
NPI:1164794772
Name:ARIZONA CENTER FOR MINIMALLY INVASIVE SURGERY LLC
Entity Type:Organization
Organization Name:ARIZONA CENTER FOR MINIMALLY INVASIVE SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:L PHILIPP
Authorized Official - Middle Name:
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-544-7266
Mailing Address - Street 1:15571 N REEMS RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-9584
Mailing Address - Country:US
Mailing Address - Phone:623-544-7266
Mailing Address - Fax:623-321-1965
Practice Address - Street 1:1475 W CHANDLER BLVD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6257
Practice Address - Country:US
Practice Address - Phone:623-544-7266
Practice Address - Fax:623-321-1965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34753261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical