MEDICARE: BSC 1 LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1114549805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BSC 1 LLC

Provider Business Mailing Address
First Line	:	2355 E CAMELBACK RD STE 700
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-9044
Country	:	US
Telephone Number	:	602-358-8512
Fax Number	:

Provider Business Practice Location Address
First Line	:	37200 N GANTZEL RD STE 100
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85140-7368
Country	:	US
Telephone Number	:	480-292-8541
Fax Number	:	480-508-4617

Authorized Official
Title or Position	:	VICE PRESIDENT OF MANAGER
Name	:	ARIC BURKE
Credential	:
Telephone Number	:	480-689-8403

Provider Enumeration Date	:	05/15/2020
Last Update Date	:	08/26/2024

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