Provider Demographics
NPI:1225119795
Name:EXABLATE OF PHOENIX
Entity Type:Organization
Organization Name:EXABLATE OF PHOENIX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL STAFF SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CLIFF
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-820-7900
Mailing Address - Street 1:2 NORTHPOINT DR
Mailing Address - Street 2:SUITE 950
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-3235
Mailing Address - Country:US
Mailing Address - Phone:281-820-7900
Mailing Address - Fax:281-820-7925
Practice Address - Street 1:9150 W INDIAN SCHOOL RD
Practice Address - Street 2:BLDG B-1, SUITE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-2384
Practice Address - Country:US
Practice Address - Phone:281-820-7900
Practice Address - Fax:281-820-7925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center