Provider Demographics
NPI:1760568224
Name:SOUTHWEST SURGERY, L.L.C.
Entity Type:Organization
Organization Name:SOUTHWEST SURGERY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:RIESDORPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-854-6500
Mailing Address - Street 1:1810 MESQUITE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5886
Mailing Address - Country:US
Mailing Address - Phone:928-854-6500
Mailing Address - Fax:928-854-6206
Practice Address - Street 1:1810 MESQUITE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5886
Practice Address - Country:US
Practice Address - Phone:928-854-6500
Practice Address - Fax:928-854-6206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31136174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty