Provider Demographics
NPI:1619199718
Name:KENNETH J PREBIL SURGERY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:KENNETH J PREBIL SURGERY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:PREBIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-486-7700
Mailing Address - Street 1:14155 N. 83RD AVE., STE. A-105
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381
Mailing Address - Country:US
Mailing Address - Phone:623-486-7700
Mailing Address - Fax:623-486-7703
Practice Address - Street 1:14155 N. 83RD AVE.,
Practice Address - Street 2:STE. A-105
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381
Practice Address - Country:US
Practice Address - Phone:623-486-7700
Practice Address - Fax:623-486-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ66040Medicare ID - Type Unspecified