Provider Demographics
NPI:1164930731
Name:REMBRANDT OUTPATIENT SURGERY CENTER PLLC
Entity Type:Organization
Organization Name:REMBRANDT OUTPATIENT SURGERY CENTER PLLC
Other - Org Name:REMBRANDT OUTPATIENT SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-766-6819
Mailing Address - Street 1:15333 N PIMA RD STE 305
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2717
Mailing Address - Country:US
Mailing Address - Phone:480-809-6266
Mailing Address - Fax:
Practice Address - Street 1:6859 E REMBRANDT AVE STE 114
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-3629
Practice Address - Country:US
Practice Address - Phone:480-809-6266
Practice Address - Fax:602-626-5077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-17
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1790879799OtherJOHN L COUVARAS