MEDICARE: COMMONS NORTH SURGERY CENTER LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207LP2900X	Pain Medicine (Anesthesiology) Physician
2	208800000X	Urology Physician
3	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1841951464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMONS NORTH SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	7102 E ACOMA DR STE 1
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-2771
Country	:	US
Telephone Number	:	602-903-0804
Fax Number	:	480-383-6248

Provider Business Practice Location Address
First Line	:	7102 E ACOMA DR
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-2771
Country	:	US
Telephone Number	:	831-588-7296
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	LEE MAREK
Credential	:	DPM
Telephone Number	:	831-588-7296

Provider Enumeration Date	:	01/05/2022
Last Update Date	:	04/19/2022

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Directions to “COMMONS NORTH SURGERY CENTER LLC ” Practice Location

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