Healthcare Provider Details

I. General information

NPI: 1639431653
Provider Name (Legal Business Name): DESERT CLIFFS SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 W SOUTHERN AVE STE 101
MESA AZ
85202-4736
US

IV. Provider business mailing address

2250 W SOUTHERN AVE STE 101
MESA AZ
85202-4736
US

V. Phone/Fax

Practice location:
  • Phone: 480-835-5532
  • Fax: 480-962-0106
Mailing address:
  • Phone: 480-835-5532
  • Fax: 480-962-0106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberOSC2478
License Number StateAZ

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DANIEL SKINNER
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 480-835-5532