Healthcare Provider Details
I. General information
NPI: 1659980209
Provider Name (Legal Business Name): ALLIANCE SURGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/29/2020
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:
III. Provider practice location address
7878 N 16TH ST STE 250
PHOENIX AZ
85020-4478
US
IV. Provider business mailing address
PO BOX 39179
PHOENIX AZ
85069-9179
US
V. Phone/Fax
- Phone: 480-773-1803
- Fax:
- Phone: 602-395-0718
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207X00000X |
| Taxonomy | Orthopaedic Surgery Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
ADAM
KUZMIAK
Title or Position: OWNER
Credential: CRNA
Phone: 516-317-6887