Healthcare Provider Details

I. General information

NPI: 1851531248
Provider Name (Legal Business Name): LASER SURGERY HOLDING COMPANY, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10255 N 32ND ST
PHOENIX AZ
85028-3851
US

IV. Provider business mailing address

10255 N 32ND ST
PHOENIX AZ
85028-3851
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 NumberOSC4560
License Number StateAZ

VIII. Authorized Official

Name: PETER THOMAS
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 602-258-7003