Healthcare Provider Details

I. General information

NPI: 1750384822
Provider Name (Legal Business Name): SURGICAL SPECIALTIES OF CASA GRANDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 E FLORENCE BLVD BLDG 2
CASA GRANDE AZ
85222-4776
US

IV. Provider business mailing address

1760 E FLORENCE BLVD BLDG 2
CASA GRANDE AZ
85222-4776
US

V. Phone/Fax

Practice location:
  • Phone: 520-421-2300
  • Fax: 520-421-2411
Mailing address:
  • Phone: 520-421-2300
  • Fax: 520-421-2411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberOSC-3188
License Number StateAZ

VIII. Authorized Official

Name: DR. BERNARD-DEAN FRANK MARUCCI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 520-421-2300