Provider Demographics
NPI:1407480999
Name:PLP SURGICAL LLC
Entity Type:Organization
Organization Name:PLP SURGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CSA
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CONNORS
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:480-772-2453
Mailing Address - Street 1:3104 E CAMELBACK RD # 1035
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4502
Mailing Address - Country:US
Mailing Address - Phone:480-772-2453
Mailing Address - Fax:480-452-1123
Practice Address - Street 1:5080 N0RTH 40ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-8501
Practice Address - Country:US
Practice Address - Phone:480-772-2453
Practice Address - Fax:480-452-1123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-24
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty