Healthcare Provider Details

I. General information

NPI: 1922034495
Provider Name (Legal Business Name): ARROWHEAD SURGICAL FIRST ASSISTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 08/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 N 16TH ST SUITE 150
PHOENIX AZ
85020-4431
US

IV. Provider business mailing address

PO BOX 39179
PHOENIX AZ
85069-9179
US

V. Phone/Fax

Practice location:
  • Phone: 602-395-0718
  • Fax: 602-277-8146
Mailing address:
  • Phone: 602-395-0718
  • Fax: 602-277-8146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberRN031133
License Number StateAZ

VIII. Authorized Official

Name: LINDA JENNINGS
Title or Position: OWNER
Credential: CMFA
Phone: 602-395-0718