Provider Demographics
NPI:1699356485
Name:ELKINS ASC LLC
Entity Type:Organization
Organization Name:ELKINS ASC LLC
Other - Org Name:GILA VALLEY PROCEDURE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-829-6776
Mailing Address - Street 1:4881 E GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2704
Mailing Address - Country:US
Mailing Address - Phone:520-829-6776
Mailing Address - Fax:520-829-6776
Practice Address - Street 1:2242 W 16TH ST STE 2246
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-4081
Practice Address - Country:US
Practice Address - Phone:520-829-6776
Practice Address - Fax:520-829-6661
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELKINS ASC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-14
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical