Provider Demographics
NPI:1316007420
Name:PALMER SURGICENTER
Entity Type:Organization
Organization Name:PALMER SURGICENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-298-2653
Mailing Address - Street 1:6740 W DEER VALLEY RD
Mailing Address - Street 2:SUITE D107-255
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-5953
Mailing Address - Country:US
Mailing Address - Phone:602-298-2653
Mailing Address - Fax:602-298-2686
Practice Address - Street 1:2699 STIRLING RD
Practice Address - Street 2:#B101
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6517
Practice Address - Country:US
Practice Address - Phone:954-989-5001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical