Provider Demographics
NPI:1659792141
Name:ARIZONA SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:ARIZONA SURGICAL ASSOCIATES
Other - Org Name:ARIZONA SURGICAL AOSSICATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-829-6100
Mailing Address - Street 1:1855 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5894
Mailing Address - Country:US
Mailing Address - Phone:480-829-6100
Mailing Address - Fax:480-245-6337
Practice Address - Street 1:1855 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5894
Practice Address - Country:US
Practice Address - Phone:480-829-6100
Practice Address - Fax:480-245-6337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4275174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ044930Medicaid
AZ2Z2488OtherHEALTH OF AZ
AZAZ0786380OtherBLUE CROSS AND BLUE SHIELD OF ARIZONA
AZ044930Medicaid