Healthcare Provider Details

I. General information

NPI: 1902768070
Provider Name (Legal Business Name): ROADRUNNER SURGICAL FIRST ASSIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 11/26/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 N SCOTTSDALE RD #368
SCOTTSDALE AZ
85252-0368
US

IV. Provider business mailing address

1776 N SCOTTSDALE RD #368
SCOTTSDALE AZ
85252-0368
US

V. Phone/Fax

Practice location:
  • Phone: 480-201-5264
  • Fax: 480-393-1970
Mailing address:
  • Phone: 480-201-5264
  • Fax: 480-393-1970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number
License Number State

VIII. Authorized Official

Name: MICHELE TUCKER
Title or Position: PRACTICE MANAGER
Credential: CPC
Phone: 480-201-5264