Healthcare Provider Details

I. General information

NPI: 1457955593
Provider Name (Legal Business Name): OUTPATIENT SURGICAL CENTER OF ARIZONA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13215 N 7TH ST STE 100
PHOENIX AZ
85022-5300
US

IV. Provider business mailing address

13215 N 7TH ST STE 100
PHOENIX AZ
85022-5300
US

V. Phone/Fax

Practice location:
  • Phone: 602-805-5041
  • Fax:
Mailing address:
  • Phone: 602-805-5041
  • Fax: 602-805-5013

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: BRIAN F GRUBER
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 602-805-5041