Provider Demographics
NPI:1467563718
Name:SURPRISE HEALTH CENTER, PLLC
Entity Type:Organization
Organization Name:SURPRISE HEALTH CENTER, PLLC
Other - Org Name:OPTUM PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-480-2550
Mailing Address - Street 1:16435 N SCOTTSDALE RD STE 400
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1745
Mailing Address - Country:US
Mailing Address - Phone:602-675-9005
Mailing Address - Fax:
Practice Address - Street 1:14973 W BELL RD
Practice Address - Street 2:#100
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3202
Practice Address - Country:US
Practice Address - Phone:623-815-2900
Practice Address - Fax:623-583-1319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ68324Medicare PIN