Healthcare Provider Details

I. General information

NPI: 1457476418
Provider Name (Legal Business Name): LASER SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 E MCDOWELL RD
PHOENIX AZ
85006-2603
US

IV. Provider business mailing address

1008 E MCDOWELL RD
PHOENIX AZ
85006-2603
US

V. Phone/Fax

Practice location:
  • Phone: 602-258-7003
  • Fax: 602-254-3474
Mailing address:
  • Phone: 602-258-7003
  • Fax: 602-254-3474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberOSC 0085
License Number StateAZ

VIII. Authorized Official

Name: DR. PETER R THOMAS
Title or Position: OWNER
Credential: M.D.
Phone: 602-258-7003