Provider Demographics
NPI:1558162362
Name:PV SURGICAL PARTNERS LLC
Entity type:Organization
Organization Name:PV SURGICAL PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCKIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-690-7604
Mailing Address - Street 1:7125 E LINCOLN DR FL 2
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-4429
Mailing Address - Country:US
Mailing Address - Phone:480-247-7454
Mailing Address - Fax:
Practice Address - Street 1:7125 E LINCOLN DR FL 2
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-4429
Practice Address - Country:US
Practice Address - Phone:480-247-7454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical