Healthcare Provider Details

I. General information

NPI: 1073155834
Provider Name (Legal Business Name): REGENCY AMBULATORY SURGERY CENTER ONE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2019
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14725 W MOUNTAIN VIEW BLVD
SURPRISE AZ
85374-2704
US

IV. Provider business mailing address

10240 W INDIAN SCHOOL RD STE 115
PHOENIX AZ
85037-5905
US

V. Phone/Fax

Practice location:
  • Phone: 623-243-9077
  • Fax: 623-271-9826
Mailing address:
  • Phone: 623-243-9077
  • Fax: 623-271-9826

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. JASON LEE MUSSMAN
Title or Position: CEO/SOLE MEMBER
Credential: MD
Phone: 623-243-9077