Provider Demographics
NPI:1437191731
Name:EL DORADO SURGERY CENTER LP
Entity Type:Organization
Organization Name:EL DORADO SURGERY CENTER LP
Other - Org Name:TUCSON SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7377
Mailing Address - Street 1:PO BOX 848236
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8236
Mailing Address - Country:US
Mailing Address - Phone:520-877-4254
Mailing Address - Fax:877-319-4035
Practice Address - Street 1:2121 N CRAYCROFT RD BLDG 8
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2801
Practice Address - Country:US
Practice Address - Phone:520-877-4254
Practice Address - Fax:877-319-4035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
AZOSC-2831261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ586068Medicaid
AZOSC10686OtherSTATE LICENSE