Healthcare Provider Details

I. General information

NPI: 1922335801
Provider Name (Legal Business Name): EAST VALLEY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2009
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 E SOUTHERN AVE
TEMPE AZ
85282-5894
US

IV. Provider business mailing address

1855 E SOUTHERN AVE BLDG B
TEMPE AZ
85282-5894
US

V. Phone/Fax

Practice location:
  • Phone: 480-829-6100
  • Fax:
Mailing address:
  • Phone: 480-829-6100
  • 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: MICHAEL JOHN ORRIS
Title or Position: OWNER
Credential: D.O.
Phone: 480-829-6100