Healthcare Provider Details

I. General information

NPI: 1013310036
Provider Name (Legal Business Name): PHOENIX SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2014
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20045 N 19TH AVE
PHOENIX AZ
85027-4252
US

IV. Provider business mailing address

PO BOX 37050
TUCSON AZ
85740-7050
US

V. Phone/Fax

Practice location:
  • Phone: 888-678-8411
  • Fax: 602-926-2736
Mailing address:
  • Phone: 888-678-8411
  • Fax: 602-926-2736

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: LIMOR PHILIPP WALL
Title or Position: PRESIDENT
Credential: MD
Phone: 888-678-8411