Provider Demographics
NPI:1982031936
Name:MODERN AMBULATORY SURGERY CENTER, PC
Entity Type:Organization
Organization Name:MODERN AMBULATORY SURGERY CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-265-8800
Mailing Address - Street 1:1301 E MCDOWELL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2621
Mailing Address - Country:US
Mailing Address - Phone:602-265-8800
Mailing Address - Fax:602-265-8151
Practice Address - Street 1:4860 E BASELINE ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4670
Practice Address - Country:US
Practice Address - Phone:602-265-8800
Practice Address - Fax:602-265-8151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-07
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical