Healthcare Provider Details

I. General information

NPI: 1235100314
Provider Name (Legal Business Name): SURGICARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 N CENTRAL AVE
PHOENIX AZ
85012-1478
US

IV. Provider business mailing address

5133 N CENTRAL AVE SUITE 200
PHOENIX AZ
85012-1438
US

V. Phone/Fax

Practice location:
  • Phone: 602-264-1818
  • Fax: 602-264-2172
Mailing address:
  • Phone: 602-264-1395
  • Fax: 602-264-2172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberOSC 0051
License Number StateAZ

VIII. Authorized Official

Name: DR. ELLISON F HERRO
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: MD
Phone: 602-264-1395