Healthcare Provider Details

I. General information

NPI: 1194661215
Provider Name (Legal Business Name): SAGUARO SURGICAL INSTITUTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14155 N 83RD AVE STE 105
PEORIA AZ
85381-5640
US

IV. Provider business mailing address

14155 N 83RD AVE STE 105
PEORIA AZ
85381-5640
US

V. Phone/Fax

Practice location:
  • Phone: 623-486-7700
  • Fax: 623-486-7703
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JARVIS WALTERS
Title or Position: PRESIDENT/OWNER
Credential: DO
Phone: 623-486-7700