Healthcare Provider Details

I. General information

NPI: 1316464159
Provider Name (Legal Business Name): AKDHC SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 08/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2580 HIGHWAY 95 STE 224
BULLHEAD CITY AZ
86442-7332
US

IV. Provider business mailing address

3333 E CAMELBACK RD STE 180
PHOENIX AZ
85018-2396
US

V. Phone/Fax

Practice location:
  • Phone: 928-704-7011
  • Fax: 928-704-7014
Mailing address:
  • Phone: 602-759-6883
  • Fax: 602-224-3315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateAZ

VIII. Authorized Official

Name: MISS ADONIS ESCOBEDO
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 602-759-6883