Provider Demographics
NPI:1528413929
Name:SOUTHWEST VALLEY SURGICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:SOUTHWEST VALLEY SURGICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-247-0300
Mailing Address - Street 1:13555 W MCDOWELL RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2626
Mailing Address - Country:US
Mailing Address - Phone:623-695-8767
Mailing Address - Fax:623-247-9268
Practice Address - Street 1:13555 W MCDOWELL RD
Practice Address - Street 2:SUITE 204
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2626
Practice Address - Country:US
Practice Address - Phone:623-695-8767
Practice Address - Fax:623-247-9268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty