Healthcare Provider Details

I. General information

NPI: 1992665772
Provider Name (Legal Business Name): MISSCPV HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3135 E LINCOLN DR STE A
PHOENIX AZ
85016-2301
US

IV. Provider business mailing address

3135 E LINCOLN DR STE A
PHOENIX AZ
85016-2301
US

V. Phone/Fax

Practice location:
  • Phone: 602-349-5040
  • Fax: 602-666-3031
Mailing address:
  • Phone: 602-349-5040
  • Fax: 602-666-3031

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: JOSHUA HUSTEDT
Title or Position: CEO
Credential: MD
Phone: 602-349-5040