Provider Demographics
NPI:1235100314
Name:SURGICARE, LLC
Entity Type:Organization
Organization Name:SURGICARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLISON
Authorized Official - Middle Name:F
Authorized Official - Last Name:HERRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-264-1395
Mailing Address - Street 1:5133 N CENTRAL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1438
Mailing Address - Country:US
Mailing Address - Phone:602-264-1395
Mailing Address - Fax:602-264-2172
Practice Address - Street 1:5115 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1478
Practice Address - Country:US
Practice Address - Phone:602-264-1818
Practice Address - Fax:602-264-2172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC 0051261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ062810Medicaid
AZAZ0201540OtherBLUECROSS BLUESHIELD AZ
AZZ110042Medicare PIN