Provider Demographics
NPI:1740681733
Name:SURGCENTER OF GREATER PHOENIX, LLC
Entity type:Organization
Organization Name:SURGCENTER OF GREATER PHOENIX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-423-4705
Mailing Address - Street 1:7231 E PRINCESS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-9671
Mailing Address - Country:US
Mailing Address - Phone:480-423-4705
Mailing Address - Fax:
Practice Address - Street 1:7231 E PRINCESS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-9671
Practice Address - Country:US
Practice Address - Phone:480-423-4705
Practice Address - Fax:480-423-4706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical