Healthcare Provider Details

I. General information

NPI: 1659731669
Provider Name (Legal Business Name): PHOENIX ASC, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 E THOMAS RD STE 102
PHOENIX AZ
85016-7767
US

IV. Provider business mailing address

1910 E THOMAS RD SUITE 102
PHOENIX AZ
85016-7766
US

V. Phone/Fax

Practice location:
  • Phone: 713-812-7586
  • Fax:
Mailing address:
  • Phone:
  • Fax: 484-924-0053

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: KELLY BEMIS
Title or Position: CHIEF CLINICAL OPS OFFICER
Credential:
Phone: 610-644-8900