Provider Demographics
NPI:1205208865
Name:ADVANCED DIAGNOSTIC & SURGICAL RECOVERY INSTITUTE, LLC
Entity Type:Organization
Organization Name:ADVANCED DIAGNOSTIC & SURGICAL RECOVERY INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:H. RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-788-3107
Mailing Address - Street 1:2155 E CONFERENCE DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-2604
Mailing Address - Country:US
Mailing Address - Phone:480-788-3107
Mailing Address - Fax:480-436-6676
Practice Address - Street 1:2155 E CONFERENCE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-2604
Practice Address - Country:US
Practice Address - Phone:480-788-3107
Practice Address - Fax:480-436-6676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QR0400X, 261QR0800X, 261QR1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch