Healthcare Provider Details

I. General information

NPI: 1346469731
Provider Name (Legal Business Name): AKDHC SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 E CAMELBACK RD STE 180
PHOENIX AZ
85018-2396
US

IV. Provider business mailing address

3333 E CAMELBACK RD SUITE 180
PHOENIX AZ
85018-2322
US

V. Phone/Fax

Practice location:
  • Phone: 602-997-1098
  • Fax: 602-943-1453
Mailing address:
  • Phone: 602-997-0484
  • Fax: 602-224-3315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateAZ

VIII. Authorized Official

Name: MS. ADONIS ESCOBEDO
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 602-759-6883