Provider Demographics
NPI:1295785418
Name:SAGUARO CHILDREN'S SURGERY LTD.
Entity type:Organization
Organization Name:SAGUARO CHILDREN'S SURGERY LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:602-294-6311
Mailing Address - Street 1:1920 E CAMBRIDGE AVE
Mailing Address - Street 2:SUITE#201
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-1459
Mailing Address - Country:US
Mailing Address - Phone:602-254-5561
Mailing Address - Fax:602-258-7640
Practice Address - Street 1:1920 E CAMBRIDGE AVE
Practice Address - Street 2:SUITE #201
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-1459
Practice Address - Country:US
Practice Address - Phone:602-254-5516
Practice Address - Fax:602-254-2185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWCHMWMedicare PIN