Healthcare Provider Details

I. General information

NPI: 1922568112
Provider Name (Legal Business Name): ANTHEM SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10611 N HAYDEN RD STE D102
SCOTTSDALE AZ
85260-8530
US

IV. Provider business mailing address

21001 N TATUM BLVD STE 1630-606
PHOENIX AZ
85050-4242
US

V. Phone/Fax

Practice location:
  • Phone: 602-354-5310
  • Fax:
Mailing address:
  • Phone:
  • Fax: 480-887-8041

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: THOMAS MOSHIRI
Title or Position: MANAGER
Credential: MD
Phone: 602-354-5310