Healthcare Provider Details

I. General information

NPI: 1518997774
Provider Name (Legal Business Name): AVONDALE SURGICAL PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10815 W MCDOWELL RD SUITE 101
AVONDALE AZ
85323
US

IV. Provider business mailing address

10815 W MCDOWELL RD SUITE 101
AVONDALE AZ
85323
US

V. Phone/Fax

Practice location:
  • Phone: 623-433-0110
  • Fax: 623-433-0111
Mailing address:
  • Phone: 623-433-0110
  • Fax: 623-433-0111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateAZ

VIII. Authorized Official

Name: DR. OWEN OWENS
Title or Position: ADMINISTRATOR
Credential: PHD
Phone: 623-433-0139