Provider Demographics
NPI:1578113809
Name:VENUS SURGICAL, LLC
Entity Type:Organization
Organization Name:VENUS SURGICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-434-6565
Mailing Address - Street 1:8415 N PIMA RD STE 292
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4488
Mailing Address - Country:US
Mailing Address - Phone:480-291-8978
Mailing Address - Fax:480-434-6572
Practice Address - Street 1:8415 N PIMA RD STE 292
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4488
Practice Address - Country:US
Practice Address - Phone:480-291-8978
Practice Address - Fax:480-434-6572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOSC9714Medicaid