Healthcare Provider Details

I. General information

NPI: 1427988641
Provider Name (Legal Business Name): ECLIPSE SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6424 E BROADWAY RD STE 102
MESA AZ
85206-1750
US

IV. Provider business mailing address

6424 E BROADWAY RD STE 102
MESA AZ
85206-1750
US

V. Phone/Fax

Practice location:
  • Phone: 480-634-4606
  • Fax: 480-452-0582
Mailing address:
  • Phone: 480-634-4606
  • Fax: 480-452-0582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRANDIE HARRISON
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 480-634-4606