Provider Demographics
NPI:1629443478
Name:SCOTTSDALE MCCORMICK RANCH SURGICENTER LLC
Entity Type:Organization
Organization Name:SCOTTSDALE MCCORMICK RANCH SURGICENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:FLINT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-689-7258
Mailing Address - Street 1:7301 E 2ND ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5600
Mailing Address - Country:US
Mailing Address - Phone:602-689-7258
Mailing Address - Fax:
Practice Address - Street 1:8129 N 87TH PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4399
Practice Address - Country:US
Practice Address - Phone:602-689-7258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical