Healthcare Provider Details

I. General information

NPI: 1255869921
Provider Name (Legal Business Name): SCOTTSDALE SURGICAL SOLUTIONS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2017
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20401 N 73RD ST STE 155
SCOTTSDALE AZ
85255-4149
US

IV. Provider business mailing address

3104 E CAMELBACK RD # 1035
PHOENIX AZ
85016-4502
US

V. Phone/Fax

Practice location:
  • Phone: 480-772-2453
  • Fax: 480-774-3255
Mailing address:
  • Phone: 480-772-2453
  • Fax: 480-774-3255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLY CONNORS
Title or Position: OFFICE MANAGER
Credential: RN
Phone: 480-772-2453