Provider Demographics
NPI:1518997774
Name:AVONDALE SURGICAL PARTNERS
Entity Type:Organization
Organization Name:AVONDALE SURGICAL PARTNERS
Other - Org Name:SURGICAL ELITE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:623-433-0139
Mailing Address - Street 1:10815 W MCDOWELL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323
Mailing Address - Country:US
Mailing Address - Phone:623-433-0110
Mailing Address - Fax:623-433-0111
Practice Address - Street 1:10815 W MCDOWELL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323
Practice Address - Country:US
Practice Address - Phone:623-433-0110
Practice Address - Fax:623-433-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ111736Medicare UPIN