Provider Demographics
NPI:1184814402
Name:SURGITECH CENTERS, INC
Entity Type:Organization
Organization Name:SURGITECH CENTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:JACOBY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:480-994-5977
Mailing Address - Street 1:7301 E 2ND ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5610
Mailing Address - Country:US
Mailing Address - Phone:480-994-5977
Mailing Address - Fax:480-990-9397
Practice Address - Street 1:7301 E 2ND ST STE 202
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5610
Practice Address - Country:US
Practice Address - Phone:480-994-5977
Practice Address - Fax:480-990-9397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ201582300OtherUS DEPT OF LABOR
AZ200000AOtherCIGNA HEALTH CARE
AZ201582300OtherUS DEPT OF LABOR
AZZ3C0001018Medicare PIN