Provider Demographics
NPI:1588833594
Name:ELK RIDGE SURGICAL SPECIALISTS PLLC
Entity Type:Organization
Organization Name:ELK RIDGE SURGICAL SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:WEHLING
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:928-537-8285
Mailing Address - Street 1:5448 WHITE MOUNTAIN BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929-5739
Mailing Address - Country:US
Mailing Address - Phone:928-537-8285
Mailing Address - Fax:928-537-8291
Practice Address - Street 1:5448 WHITE MOUNTAIN BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929-5739
Practice Address - Country:US
Practice Address - Phone:928-537-8285
Practice Address - Fax:928-537-8291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-23
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47782086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty