Healthcare Provider Details

I. General information

NPI: 1780205294
Provider Name (Legal Business Name): NATIONAL CARDIOVASCULAR SURGERY CENTER OF SURPRISE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12361 W BOLA DR STE 112
SURPRISE AZ
85378-9021
US

IV. Provider business mailing address

PO BOX 41638
PHOENIX AZ
85080-1638
US

V. Phone/Fax

Practice location:
  • Phone: 844-900-2567
  • Fax:
Mailing address:
  • Phone: 602-899-4404
  • 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: TIMOTHY COZATT
Title or Position: INVESTOR RELATIONS OFFICER
Credential:
Phone: 602-899-4404