Healthcare Provider Details

I. General information

NPI: 1811654494
Provider Name (Legal Business Name): ASAP SURGERY CENTERS NORTH VALLEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 W GREENWAY RD STE 100
PHOENIX AZ
85023-4280
US

IV. Provider business mailing address

2525 W GREENWAY RD STE 100
PHOENIX AZ
85023-4280
US

V. Phone/Fax

Practice location:
  • Phone: 480-573-0213
  • Fax:
Mailing address:
  • Phone: 480-573-0213
  • 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: JARRETT LEATHEM
Title or Position: OWNER, AUTHORIZED AGENT
Credential: MD
Phone: 480-573-0130