Healthcare Provider Details

I. General information

NPI: 1003781196
Provider Name (Legal Business Name): DCH SURGICAL ASSIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 10/08/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3940 E CRITTENDEN LANE
PHOENIX AZ
85018
US

IV. Provider business mailing address

3104 E CAMELBACK RD # 1035
PHOENIX AZ
85016-4502
US

V. Phone/Fax

Practice location:
  • Phone: 480-784-7428
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: KELLY CONNORS
Title or Position: OWNER
Credential: CSA, RN
Phone: 480-784-7428