Healthcare Provider Details

I. General information

NPI: 1699356485
Provider Name (Legal Business Name): ELKINS ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2242 W 16TH ST STE 2246
SAFFORD AZ
85546-4081
US

IV. Provider business mailing address

4881 E GRANT RD
TUCSON AZ
85712-2704
US

V. Phone/Fax

Practice location:
  • Phone: 520-829-6776
  • Fax: 520-829-6661
Mailing address:
  • Phone: 520-829-6776
  • Fax: 520-829-6776

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: JOHN H COLE
Title or Position: CEO
Credential:
Phone: 520-829-6776