Provider Demographics
NPI:1679826051
Name:AZ RICHARDSON SURGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:AZ RICHARDSON SURGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:480-586-0554
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85252-0368
Mailing Address - Country:US
Mailing Address - Phone:480-201-5264
Mailing Address - Fax:480-393-1970
Practice Address - Street 1:1776 N SCOTTSDALE RD UNIT 368
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85252-3616
Practice Address - Country:US
Practice Address - Phone:480-201-5264
Practice Address - Fax:480-393-1970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2908363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty