Healthcare Provider Details

I. General information

NPI: 1255265195
Provider Name (Legal Business Name): OA WEST VALLEY SURGICAL PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9070 W GLENDALE AVE STE 110
GLENDALE AZ
85305-1120
US

IV. Provider business mailing address

9070 W GLENDALE AVE STE 110
GLENDALE AZ
85305-1120
US

V. Phone/Fax

Practice location:
  • Phone: 623-266-7788
  • Fax: 623-321-9517
Mailing address:
  • Phone:
  • 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: JAY MCKIM
Title or Position: EVP CHIEF FINANCIAL OFFICER
Credential:
Phone: 949-680-3443