Provider Demographics
NPI:1851946875
Name:EAST VALLEY OUTPATIENT SURGERY, LLC
Entity Type:Organization
Organization Name:EAST VALLEY OUTPATIENT SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-981-6111
Mailing Address - Street 1:5620 E BROADWAY RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1438
Mailing Address - Country:US
Mailing Address - Phone:480-981-6111
Mailing Address - Fax:
Practice Address - Street 1:5620 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1438
Practice Address - Country:US
Practice Address - Phone:480-981-6111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-06
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical