Provider Demographics
NPI:1760513824
Name:RAAD TAKI SURGERY CENTER
Entity Type:Organization
Organization Name:RAAD TAKI SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:GROBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:520-881-3232
Mailing Address - Street 1:4580 E CAMP LOWELL DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1282
Mailing Address - Country:US
Mailing Address - Phone:520-881-3232
Mailing Address - Fax:520-881-3535
Practice Address - Street 1:4580 E CAMP LOWELL DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1282
Practice Address - Country:US
Practice Address - Phone:520-881-3232
Practice Address - Fax:520-881-3535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ 27306174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty