Healthcare Provider Details

I. General information

NPI: 1376998666
Provider Name (Legal Business Name): SWAN SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 N SWAN RD # 101
TUCSON AZ
85712-4044
US

IV. Provider business mailing address

1505 N SWAN RD
TUCSON AZ
85712-4078
US

V. Phone/Fax

Practice location:
  • Phone: 520-795-3090
  • Fax:
Mailing address:
  • Phone: 520-795-3090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0000000
License Number StateAZ

VIII. Authorized Official

Name: DR. FADI DEEB
Title or Position: OWNER
Credential:
Phone: 520-795-3090