Provider Demographics
NPI:1376507616
Name:GRANDVIEW SURGICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:GRANDVIEW SURGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GIANGOBBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-584-7874
Mailing Address - Street 1:13629 W CAMINO DEL SOL
Mailing Address - Street 2:STE 180
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-1405
Mailing Address - Country:US
Mailing Address - Phone:623-584-7874
Mailing Address - Fax:623-584-8137
Practice Address - Street 1:13629 W CAMINO DEL SOL
Practice Address - Street 2:STE 180
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-1405
Practice Address - Country:US
Practice Address - Phone:623-584-7874
Practice Address - Fax:623-584-8137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23204208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG06514Medicare UPIN
AZZ72042Medicare ID - Type Unspecified