Healthcare Provider Details

I. General information

NPI: 1386566974
Provider Name (Legal Business Name): AZ CARDIOLOGY SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9192 W UNION HILLS DR STE 103
PEORIA AZ
85382-8209
US

IV. Provider business mailing address

9191 W THUNDERBIRD RD STE D105
PEORIA AZ
85381-4270
US

V. Phone/Fax

Practice location:
  • Phone: 602-654-1950
  • Fax:
Mailing address:
  • Phone: 520-262-0675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JASON MILLER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 520-262-0675