Healthcare Provider Details

I. General information

NPI: 1285138081
Provider Name (Legal Business Name): SCOTTSDALE SURGERY CENTER ONE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 E RAINTREE DR
SCOTTSDALE AZ
85260-7307
US

IV. Provider business mailing address

PO BOX 207427
DALLAS TX
75320-7433
US

V. Phone/Fax

Practice location:
  • Phone: 480-625-0003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PABLO PRICHARD
Title or Position: OWNER
Credential: MD
Phone: 480-625-0003