MEDICARE: SCOTTSDALE SURGICAL ASSISTANTS INC

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	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1417096272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTTSDALE SURGICAL ASSISTANTS INC

Provider Business Mailing Address
First Line	:	4340 E INDIAN SCHOOL RD
Second Line	:	STE 21-562
City	:	PHOENIX
State	:	AZ
Zip	:	85018-5360
Country	:	US
Telephone Number	:	480-545-2610
Fax Number	:	480-545-2673

Provider Business Practice Location Address
First Line	:	4340 E INDIAN SCHOOL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-5360
Country	:	US
Telephone Number	:	480-545-2610
Fax Number	:	480-545-2673

Authorized Official
Title or Position	:	OWNER
Name	:	COREY L THOMPSON
Credential	:	PA-C
Telephone Number	:	480-545-2610

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	12/22/2014

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