Provider Demographics
NPI:1629559208
Name:ORTHOARIZONA SURGERY CENTER GILBERT, LLC
Entity type:Organization
Organization Name:ORTHOARIZONA SURGERY CENTER GILBERT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER / AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-567-0269
Mailing Address - Street 1:1675 E MELROSE ST UNIT 201
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-1002
Mailing Address - Country:US
Mailing Address - Phone:480-519-8100
Mailing Address - Fax:480-718-7690
Practice Address - Street 1:1675 E. MELROSE STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7500
Practice Address - Country:US
Practice Address - Phone:480-519-8100
Practice Address - Fax:480-718-7690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical