Healthcare Provider Details

I. General information

NPI: 1598226268
Provider Name (Legal Business Name): SURGICAL & PAIN CENTER OF SCOTTSDALE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2629 N SCOTTSDALE RD STE 101
SCOTTSDALE AZ
85257-1370
US

IV. Provider business mailing address

2629 N SCOTTSDALE RD STE 100
SCOTTSDALE AZ
85257-1370
US

V. Phone/Fax

Practice location:
  • Phone: 480-550-6493
  • Fax: 602-297-6997
Mailing address:
  • Phone: 602-510-3203
  • 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: SAM FARNOUSH
Title or Position: ADMINISTRATOR
Credential: MD
Phone: 602-882-3683