Provider Demographics
NPI:1336687326
Name:ARROWHEAD SURGERY CENTER LLC
Entity Type:Organization
Organization Name:ARROWHEAD SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:DEPENBUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-272-2686
Mailing Address - Street 1:1500 W RAY RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-0002
Mailing Address - Country:US
Mailing Address - Phone:480-963-3881
Mailing Address - Fax:480-899-8610
Practice Address - Street 1:1500 W RAY RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-0002
Practice Address - Country:US
Practice Address - Phone:480-963-3881
Practice Address - Fax:480-899-8610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ103779Medicare PIN
AZG48777Medicare UPIN