Healthcare Provider Details

I. General information

NPI: 1801876941
Provider Name (Legal Business Name): SKIN CANCER TREATMENT CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13128 N 94TH DR SUITE #101A
PEORIA AZ
85381-4254
US

IV. Provider business mailing address

13128 N 94TH DR SUITE #101A
PEORIA AZ
85381-4254
US

V. Phone/Fax

Practice location:
  • Phone: 623-875-2600
  • Fax: 623-875-2621
Mailing address:
  • Phone: 623-875-2600
  • Fax: 623-875-2621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberOSC3048
License Number StateAZ

VIII. Authorized Official

Name: DR. PATRICIA ANN CARROLL-CHEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 623-875-2600