Provider Demographics
NPI:1497165179
Name:SURGERY CENTER OF SCOTTSDALE, LLC
Entity Type:Organization
Organization Name:SURGERY CENTER OF SCOTTSDALE, LLC
Other - Org Name:MOUNTAIN VIEW SURGERY CENTER OF PHOENIX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER / AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENETHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3893
Mailing Address - Street 1:3131 W PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-5226
Mailing Address - Country:US
Mailing Address - Phone:480-398-8456
Mailing Address - Fax:480-584-3026
Practice Address - Street 1:3131 W PEORIA AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-5226
Practice Address - Country:US
Practice Address - Phone:602-375-1083
Practice Address - Fax:602-789-6833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC6563261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ167073Medicare PIN