MEDICARE: SQUAW PEAK SURGICAL FACILITY 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	261QA1903X	Ambulatory Surgical Clinic/Center	OSC1965	AZ

General Provider Information

NPI Number	:	1871513705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SQUAW PEAK SURGICAL FACILITY INC

Provider Business Mailing Address
First Line	:	1635 E MYRTLE #100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-0000
Country	:	US
Telephone Number	:	602-944-5656
Fax Number	:	602-944-2727

Provider Business Practice Location Address
First Line	:	1635 E MYRTLE #100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-0000
Country	:	US
Telephone Number	:	602-944-5656
Fax Number	:	602-944-2727

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANTHONY T YEUNG
Credential	:	MD
Telephone Number	:	602-944-5656

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/07/2022

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