Healthcare Provider Details

I. General information

NPI: 1376176115
Provider Name (Legal Business Name): REGENCY AMBULATORY SURGERY CENTER ONE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14725 W MOUNTAIN VIEW BLVD
SURPRISE AZ
85374-2704
US

IV. Provider business mailing address

14753 W MOUNTAIN VIEW BLVD
SURPRISE AZ
85374
US

V. Phone/Fax

Practice location:
  • Phone: 623-243-9077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JASON MUSSMAN
Title or Position: OWNER
Credential:
Phone: 623-243-9077