Healthcare Provider Details

I. General information

NPI: 1699777540
Provider Name (Legal Business Name): PHYSICIANS SURGERY CENTER OF TEMPE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 E SOUTHERN AVE
TEMPE AZ
85282
US

IV. Provider business mailing address

14201 DALLAS PKWY
DALLAS TX
75254-2916
US

V. Phone/Fax

Practice location:
  • Phone: 480-820-7101
  • Fax: 480-820-9291
Mailing address:
  • Phone: 727-633-8939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberOSC0043
License Number StateAZ

VIII. Authorized Official

Name: ERIC BOON
Title or Position: OFFICER, AUTHORIZED OFFICIAL
Credential:
Phone: 480-567-0269