Provider Demographics
NPI:1225433642
Name:ASC TEMPE LLC
Entity Type:Organization
Organization Name:ASC TEMPE LLC
Other - Org Name:ICON SURGERY CENTER OF TEMPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-341-3399
Mailing Address - Street 1:201 FILLMORE ST
Mailing Address - Street 2:STE. 201
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:940 E UNIVERSITY DR
Practice Address - Street 2:STE. 102
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-4278
Practice Address - Country:US
Practice Address - Phone:623-500-6072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical