Healthcare Provider Details

I. General information

NPI: 1851567291
Provider Name (Legal Business Name): KHATALI AMBULATORY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10450 E RIGGS RD SUITE 101
SUN LAKES AZ
85248-7758
US

IV. Provider business mailing address

10450 E RIGGS RD STE 101
SUN LAKES AZ
85248-7759
US

V. Phone/Fax

Practice location:
  • Phone: 480-636-5634
  • Fax:
Mailing address:
  • Phone: 414-258-9511
  • Fax: 414-607-3948

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: DR. DAVID N CALKINS
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 480-636-5634