Provider Demographics
NPI:1720199607
Name:SOUTHWEST SURGERY OF YAVAPAI COUNTY, PC
Entity Type:Organization
Organization Name:SOUTHWEST SURGERY OF YAVAPAI COUNTY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SCHILPEROORT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-445-3055
Mailing Address - Street 1:2001 EXCELLENCE WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-8410
Mailing Address - Country:US
Mailing Address - Phone:928-445-3055
Mailing Address - Fax:928-445-4732
Practice Address - Street 1:2001 EXCELLENCE WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-8410
Practice Address - Country:US
Practice Address - Phone:928-445-3055
Practice Address - Fax:928-445-4732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25877208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0893130OtherBLUE CROSS BLUE SHIELD
AZ401612Medicaid
AZ2015283OtherCIGNA
AZE74309Medicare UPIN
AZZ68102Medicare PIN
AZ2015283OtherCIGNA