Healthcare Provider Details

I. General information

NPI: 1639982960
Provider Name (Legal Business Name): ATLAS OUTPATIENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16390 N 59TH AVE STE 100
GLENDALE AZ
85306-1711
US

IV. Provider business mailing address

18205 N 51ST AVE STE 125
GLENDALE AZ
85308-1491
US

V. Phone/Fax

Practice location:
  • Phone: 602-492-9821
  • Fax: 602-492-9822
Mailing address:
  • Phone: 602-492-9821
  • Fax: 602-492-9822

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: SEAN M ORMOND
Title or Position: CEO
Credential: MD
Phone: 602-492-9822