Provider Demographics
NPI:1457023269
Name:PHOENIX SURGICAL SERVICES
Entity Type:Organization
Organization Name:PHOENIX SURGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RNFA
Authorized Official - Prefix:
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:ROMERO
Authorized Official - Last Name:SOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:BSN,RN,CNOR,RNFA
Authorized Official - Phone:708-263-5092
Mailing Address - Street 1:PO BOX 2494
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1091
Mailing Address - Country:US
Mailing Address - Phone:708-263-5092
Mailing Address - Fax:708-301-6148
Practice Address - Street 1:13223 BAYWOOD LN
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-5991
Practice Address - Country:US
Practice Address - Phone:708-263-5092
Practice Address - Fax:708-301-6148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-30
Last Update Date:2021-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty