Healthcare Provider Details

I. General information

NPI: 1528526969
Provider Name (Legal Business Name): KSP CENTER FOR SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8573 E PRINCESS DR STE B110
SCOTTSDALE AZ
85255-7819
US

IV. Provider business mailing address

8573 E PRINCESS DR STE B110
SCOTTSDALE AZ
85255-7819
US

V. Phone/Fax

Practice location:
  • Phone: 480-946-9900
  • Fax:
Mailing address:
  • Phone: 480-946-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0006X
TaxonomyAmbulatory Fertility Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. KETAN PATEL
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 480-946-9900