Provider Demographics
NPI:1255869921
Name:SCOTTSDALE SURGICAL SOLUTIONS PC
Entity type:Organization
Organization Name:SCOTTSDALE SURGICAL SOLUTIONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNORS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:480-772-2453
Mailing Address - Street 1:3104 E CAMELBACK RD # 1035
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4502
Mailing Address - Country:US
Mailing Address - Phone:480-772-2453
Mailing Address - Fax:480-774-3255
Practice Address - Street 1:20401 N 73RD ST STE 155
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4149
Practice Address - Country:US
Practice Address - Phone:480-772-2453
Practice Address - Fax:480-774-3255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-25
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1013541507OtherNPI