Healthcare Provider Details

I. General information

NPI: 1437720828
Provider Name (Legal Business Name): TEMPE AMBULATORY SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 E CONFERENCE DR STE 111
TEMPE AZ
85284-2604
US

IV. Provider business mailing address

3400 WATERVIEW PKWY STE 305
RICHARDSON TX
75080-1566
US

V. Phone/Fax

Practice location:
  • Phone: 214-551-0257
  • Fax:
Mailing address:
  • Phone: 214-295-6703
  • 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: ADRIANNA VILLARREAL
Title or Position: ADMINISTRATOR
Credential:
Phone: 214-551-0257