Provider Demographics
NPI:1376203174
Name:AZ SURGICAL SUPPORT, PLLC
Entity Type:Organization
Organization Name:AZ SURGICAL SUPPORT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-689-5104
Mailing Address - Street 1:1847 E SOUTHERN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5881
Mailing Address - Country:US
Mailing Address - Phone:480-689-5104
Mailing Address - Fax:
Practice Address - Street 1:1855 E SOUTHERN AVE STE 4
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5894
Practice Address - Country:US
Practice Address - Phone:480-689-5104
Practice Address - Fax:480-245-6337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty