Healthcare Provider Details

I. General information

NPI: 1164821112
Provider Name (Legal Business Name): ARIZONA SURGICAL ASSOCIATES, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 08/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9305 W THOMAS RD STE 480
PHOENIX AZ
85037-3375
US

IV. Provider business mailing address

1855 E SOUTHERN AVE BLDG A
TEMPE AZ
85282-5894
US

V. Phone/Fax

Practice location:
  • Phone: 480-829-6100
  • Fax: 480-446-9475
Mailing address:
  • Phone: 480-829-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number006189
License Number StateAZ

VIII. Authorized Official

Name: BENJAMIN MOORE
Title or Position: OFFICE MANAGER
Credential:
Phone: 480-829-6100