Provider Demographics
NPI:1649598152
Name:MEDICAL AND SURGICAL HEALTH AND HEALING INSTITUTE, L.L.C.
Entity Type:Organization
Organization Name:MEDICAL AND SURGICAL HEALTH AND HEALING INSTITUTE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VONNEE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-975-2500
Mailing Address - Street 1:15515 N REEMS RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-9549
Mailing Address - Country:US
Mailing Address - Phone:623-975-2500
Mailing Address - Fax:623-975-1900
Practice Address - Street 1:15515 N REEMS RD
Practice Address - Street 2:SUITE 107
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-9549
Practice Address - Country:US
Practice Address - Phone:623-975-2500
Practice Address - Fax:623-975-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-07
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ535447Medicaid
AZ535447Medicaid