Healthcare Provider Details

I. General information

NPI: 1306843222
Provider Name (Legal Business Name): ST. JOSEPH'S OUTPATIENT SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 W THOMAS RD
PHOENIX AZ
85013-4407
US

IV. Provider business mailing address

240 W THOMAS RD
PHOENIX AZ
85013-4407
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-3552
  • Fax: 602-406-7139
Mailing address:
  • Phone: 602-406-3552
  • Fax: 602-406-7139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberOSC3456
License Number StateAZ

VIII. Authorized Official

Name: ERIC BOON
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 480-567-0269