Provider Demographics
NPI:1790093813
Name:AZ WEST ENDOSCOPY CENTER LLC
Entity Type:Organization
Organization Name:AZ WEST ENDOSCOPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SABLYAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-589-9001
Mailing Address - Street 1:1850 N 95TH AVE
Mailing Address - Street 2:SUITE 190
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-4317
Mailing Address - Country:US
Mailing Address - Phone:623-594-4060
Mailing Address - Fax:623-594-8736
Practice Address - Street 1:1850 N 95TH AVE
Practice Address - Street 2:SUITE 190
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-4317
Practice Address - Country:US
Practice Address - Phone:623-594-4060
Practice Address - Fax:623-594-8736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ677816Medicaid
03C0001335Medicare Oscar/Certification
Z147260Medicare PIN