Healthcare Provider Details

I. General information

NPI: 1376096776
Provider Name (Legal Business Name): REPRO SURGICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 12/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 N PIMA RD SUITE 291
SCOTTSDALE AZ
85258-4480
US

IV. Provider business mailing address

8415 N PIMA RD SUITE 291
SCOTTSDALE AZ
85258-4480
US

V. Phone/Fax

Practice location:
  • Phone: 919-641-6024
  • Fax: 480-434-6572
Mailing address:
  • Phone: 919-641-6024
  • Fax: 480-434-6572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number42873
License Number StateAZ

VIII. Authorized Official

Name: DR. MILLIE BEHERA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 919-641-6024