Healthcare Provider Details

I. General information

NPI: 1073709689
Provider Name (Legal Business Name): NORTH MOUNTAIN SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 N 3RD ST SUITE 101
PHOENIX AZ
85020
US

IV. Provider business mailing address

PO BOX 47510 9250 N 3RD ST SUITE 101
PHOENIX AZ
85068-7510
US

V. Phone/Fax

Practice location:
  • Phone: 602-903-0360
  • Fax:
Mailing address:
  • Phone: 602-903-0360
  • Fax:

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: MS. SUSAN L NANCE
Title or Position: EXECUTIVE DIRECTOR
Credential: RN, CNOR, CASC
Phone: 602-903-0360