Healthcare Provider Details

I. General information

NPI: 1417096272
Provider Name (Legal Business Name): SCOTTSDALE SURGICAL ASSISTANTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4340 E INDIAN SCHOOL RD
PHOENIX AZ
85018-5360
US

IV. Provider business mailing address

4340 E INDIAN SCHOOL RD STE 21-562
PHOENIX AZ
85018-5360
US

V. Phone/Fax

Practice location:
  • Phone: 480-545-2610
  • Fax: 480-545-2673
Mailing address:
  • Phone: 480-545-2610
  • Fax: 480-545-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: COREY L THOMPSON
Title or Position: OWNER
Credential: PA-C
Phone: 480-545-2610