Provider Demographics
NPI:1245613256
Name:PARADISE VALLEY SURGERY CENTER
Entity Type:Organization
Organization Name:PARADISE VALLEY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BILAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-254-6369
Mailing Address - Street 1:4400 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE 9, #98
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3331
Mailing Address - Country:US
Mailing Address - Phone:602-254-6369
Mailing Address - Fax:602-254-6372
Practice Address - Street 1:1008 E MCDOWELL RD
Practice Address - Street 2:SUITE C
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2603
Practice Address - Country:US
Practice Address - Phone:602-254-6369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC7168261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical