Healthcare Provider Details

I. General information

NPI: 1578058897
Provider Name (Legal Business Name): UPTOWN SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 11/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

5133 N CENTRAL AVE STE 100
PHOENIX AZ
85012-1438
US

V. Phone/Fax

Practice location:
  • Phone: 602-279-0044
  • Fax:
Mailing address:
  • Phone: 602-279-0044
  • Fax:

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: NIKKI VAUGHAN
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 602-279-0044