Healthcare Provider Details

I. General information

NPI: 1063408649
Provider Name (Legal Business Name): AIMS OUTPATIENT SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 N STOCKTON HILL RD
KINGMAN AZ
86409
US

IV. Provider business mailing address

3636 N STOCKTON HILL RD
KINGMAN AZ
86409-0514
US

V. Phone/Fax

Practice location:
  • Phone: 928-757-3690
  • Fax: 928-757-3635
Mailing address:
  • Phone: 928-757-3690
  • Fax: 928-757-3635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberOSC0074
License Number StateAZ

VIII. Authorized Official

Name: MR. AZAM S. KHAN
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 928-757-3636