Healthcare Provider Details

I. General information

NPI: 1902881295
Provider Name (Legal Business Name): SURGICAL SPECIALTY HOSPITAL OF ARIZONA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 N 19TH AVE
PHOENIX AZ
85015-1646
US

IV. Provider business mailing address

6501 N 19TH AVE
PHOENIX AZ
85015-1646
US

V. Phone/Fax

Practice location:
  • Phone: 602-795-6020
  • Fax: 602-795-6022
Mailing address:
  • Phone: 602-795-6020
  • Fax: 602-795-6022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number State

VIII. Authorized Official

Name: ERIC TOMLON
Title or Position: CHIEF OF ADMINISTRATION & STAFF OFF
Credential:
Phone: 623-537-5605