Healthcare Provider Details

I. General information

NPI: 1467906685
Provider Name (Legal Business Name): PREMIER SURGERY CENTER OF ARIZONA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 E BASELINE ROAD SUITE 104
GILBERT AZ
85234-2739
US

IV. Provider business mailing address

3303 E BASELINE ROAD SUITE 104
GILBERT AZ
85234-2739
US

V. Phone/Fax

Practice location:
  • Phone: 480-632-2020
  • Fax: 480-632-2121
Mailing address:
  • Phone: 480-632-2020
  • Fax: 480-632-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KIANOUSH KIAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 480-632-2020