Provider Demographics
NPI:1356799191
Name:ARIZONA SURGICAL ASSIST PLLC
Entity type:Organization
Organization Name:ARIZONA SURGICAL ASSIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REMUS
Authorized Official - Middle Name:
Authorized Official - Last Name:REPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-377-3782
Mailing Address - Street 1:2730 S VAL VISTA DRIVE
Mailing Address - Street 2:BUILDING 4 SUITE 117
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295
Mailing Address - Country:US
Mailing Address - Phone:855-377-3782
Mailing Address - Fax:833-235-3700
Practice Address - Street 1:3271 N CIVIC CENTER PLZ STE 105
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6990
Practice Address - Country:US
Practice Address - Phone:855-377-3782
Practice Address - Fax:928-268-3517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37978208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty