Provider Demographics
NPI:1952917445
Name:AURORA SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:AURORA SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CONNOR
Authorized Official - Middle Name:W
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-395-3296
Mailing Address - Street 1:1254 W UNIVERSITY AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-7217
Mailing Address - Country:US
Mailing Address - Phone:928-395-3296
Mailing Address - Fax:
Practice Address - Street 1:1254 W UNIVERSITY AVE STE 130
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-7217
Practice Address - Country:US
Practice Address - Phone:928-395-3296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-20
Last Update Date:2020-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical