Healthcare Provider Details

I. General information

NPI: 1760907919
Provider Name (Legal Business Name): BANNER SUN CITY WEST SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14416 W MEEKER BLVD STE 103
SUN CITY AZ
85375-5284
US

IV. Provider business mailing address

2901 N CENTRAL AVE STE 160
PHOENIX AZ
85012-2702
US

V. Phone/Fax

Practice location:
  • Phone: 623-234-3675
  • Fax: 602-865-1609
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: MATTHEW COX
Title or Position: SR VP FINANCE
Credential:
Phone: 602-747-4000