Provider Demographics
NPI:1548203888
Name:NORTH VALLEY ORTHOPEDIC SURGERY CENTER LLC
Entity Type:Organization
Organization Name:NORTH VALLEY ORTHOPEDIC SURGERY CENTER LLC
Other - Org Name:THE ORTHOPEDIC SURGERY CENTER OF ARIZONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-567-0269
Mailing Address - Street 1:2262 E ROSE GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-4497
Mailing Address - Country:US
Mailing Address - Phone:602-483-4371
Mailing Address - Fax:
Practice Address - Street 1:2262 E. ROSE GARDEN LANE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024
Practice Address - Country:US
Practice Address - Phone:602-424-4408
Practice Address - Fax:602-424-4409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC 4036261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ112571Medicare PIN