Healthcare Provider Details

I. General information

NPI: 1932644606
Provider Name (Legal Business Name): INNOVATIVE SURGERY CENTER PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15547 N REEMS RD BLDG A
SURPRISE AZ
85374-9583
US

IV. Provider business mailing address

15547 N REEMS RD BLDG A
SURPRISE AZ
85374-9583
US

V. Phone/Fax

Practice location:
  • Phone: 623-535-9777
  • Fax:
Mailing address:
  • Phone: 623-535-9777
  • 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: WENDI J LUNDQUIST
Title or Position: PHYSICAIN/OWNER
Credential: D.O.
Phone: 623-535-9777