Provider Demographics
NPI:1942624622
Name:OLIVE SURGICAL CARE, LLC
Entity Type:Organization
Organization Name:OLIVE SURGICAL CARE, LLC
Other - Org Name:DESERT VISTA SURGERY CENTER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:LATOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-547-5420
Mailing Address - Street 1:8914 N 91ST AVE
Mailing Address - Street 2:SUITE 100-A
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-8396
Mailing Address - Country:US
Mailing Address - Phone:623-547-5420
Mailing Address - Fax:623-594-8936
Practice Address - Street 1:8914 N 91ST AVE
Practice Address - Street 2:SUITE 100-A
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-8396
Practice Address - Country:US
Practice Address - Phone:623-547-5420
Practice Address - Fax:623-594-8936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC5845261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical