Provider Demographics
NPI:1558923656
Name:SHEA SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:SHEA SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:ZOLDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-307-8258
Mailing Address - Street 1:1450 W GUADALUPE RD STE 124
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3056
Mailing Address - Country:US
Mailing Address - Phone:480-307-8258
Mailing Address - Fax:
Practice Address - Street 1:10611 N HAYDEN RD STE D102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-8530
Practice Address - Country:US
Practice Address - Phone:602-441-3573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-28
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical