Provider Demographics
NPI:1265572606
Name:UNITED SURGICAL ASSOCIATES, L.L.C.
Entity type:Organization
Organization Name:UNITED SURGICAL ASSOCIATES, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITHSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:928-649-4480
Mailing Address - Street 1:651 W MINGUS AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4006
Mailing Address - Country:US
Mailing Address - Phone:928-649-4480
Mailing Address - Fax:928-634-8118
Practice Address - Street 1:651 W MINGUS AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4006
Practice Address - Country:US
Practice Address - Phone:928-649-4480
Practice Address - Fax:928-634-8118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC 3418261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ820680Medicaid
AZAZ0208760OtherBCBS ID
AZ=========OtherALL OTHER INSURANCES
AZAZ0208760OtherBCBS ID