Healthcare Provider Details

I. General information

NPI: 1104894369
Provider Name (Legal Business Name): VALLEY OUTPATIENT SURGICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 W UNIVERSITY STE 1
MESA AZ
85201
US

IV. Provider business mailing address

160 W UNIVERSITY STE 1
MESA AZ
85201
US

V. Phone/Fax

Practice location:
  • Phone: 480-835-7373
  • Fax: 480-835-6821
Mailing address:
  • Phone: 480-835-7373
  • Fax: 480-835-6821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberOSC0034
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SANFORD L MORETSKY
Title or Position: OWNER PHYSICIAN
Credential: DO
Phone: 480-833-0014