Healthcare Provider Details

I. General information

NPI: 1801028048
Provider Name (Legal Business Name): WESTERN SURGICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2009
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7672 E DAVENPORT DR
SCOTTSDALE AZ
85260-4020
US

IV. Provider business mailing address

PO BOX 12144
SCOTTSDALE AZ
85267-2144
US

V. Phone/Fax

Practice location:
  • Phone: 602-708-2493
  • Fax: 480-699-6264
Mailing address:
  • Phone: 602-708-2493
  • Fax: 480-699-6264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number1597297
License Number StateAZ

VIII. Authorized Official

Name: CRYSTAL RAE CODDINGTON
Title or Position: SOLE MEMBER
Credential: CFA
Phone: 602-708-2493