Provider Demographics
NPI:1407465081
Name:ARIZONA ADVANCED SURGICAL AND PAIN
Entity Type:Organization
Organization Name:ARIZONA ADVANCED SURGICAL AND PAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-826-5090
Mailing Address - Street 1:5235 E SOUTHERN AVE STE D106-444
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3626
Mailing Address - Country:US
Mailing Address - Phone:602-826-5090
Mailing Address - Fax:480-776-0046
Practice Address - Street 1:5235 E SOUTHERN AVE STE D106-444
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3626
Practice Address - Country:US
Practice Address - Phone:480-776-0041
Practice Address - Fax:480-776-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ23075882OtherARIZONA CORPORATE COMMISSION