Healthcare Provider Details

I. General information

NPI: 1174185649
Provider Name (Legal Business Name): PISA ASC HOLDCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4741 E CAMP LOWELL DRIVE
TUCSON AZ
85712
US

IV. Provider business mailing address

4741 E CAMP LOWELL DR
TUCSON AZ
85712-1256
US

V. Phone/Fax

Practice location:
  • Phone: 520-318-6035
  • Fax: 520-795-9953
Mailing address:
  • Phone: 520-829-6620
  • 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: GREG TURK
Title or Position: DIRECTOR/OFFICER
Credential:
Phone: 520-333-7730