Healthcare Provider Details

I. General information

NPI: 1659683662
Provider Name (Legal Business Name): PREMIER ENDOSCOPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2563 S VAL VISTA DR STE 101A
GILBERT AZ
85295-6231
US

IV. Provider business mailing address

2525 W GREENWAY RD STE 300
PHOENIX AZ
85023-4292
US

V. Phone/Fax

Practice location:
  • Phone: 480-573-0213
  • Fax: 480-573-0214
Mailing address:
  • Phone: 480-573-0213
  • Fax:

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: JARRETT LEATHEM
Title or Position: DO, OWNER
Credential:
Phone: 480-573-0130