Healthcare Provider Details

I. General information

NPI: 1841842747
Provider Name (Legal Business Name): SCOTTSDALE OUTPATIENT SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8994 E DESERT COVE AVE STE 101
SCOTTSDALE AZ
85260-7901
US

IV. Provider business mailing address

8994 E DESERT COVE AVE STE 101
SCOTTSDALE AZ
85260-7901
US

V. Phone/Fax

Practice location:
  • Phone: 602-510-3203
  • Fax: 602-297-6997
Mailing address:
  • Phone: 602-510-3203
  • Fax: 602-297-6997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TINA MANKIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 602-510-3203