Provider Demographics
NPI:1649662206
Name:ADVANCED SURGERY CENTER OF ARIZONA, LLP
Entity type:Organization
Organization Name:ADVANCED SURGERY CENTER OF ARIZONA, LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:DATTILO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-666-9329
Mailing Address - Street 1:10255 N 32ND ST STE A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3822
Mailing Address - Country:US
Mailing Address - Phone:480-666-9329
Mailing Address - Fax:480-616-2963
Practice Address - Street 1:10255 N 32ND ST STE A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3822
Practice Address - Country:US
Practice Address - Phone:480-666-9329
Practice Address - Fax:480-616-2963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-19
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QS0132X, 207W00000X
AZ261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic SurgeryGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty