Healthcare Provider Details

I. General information

NPI: 1386319143
Provider Name (Legal Business Name): BAY STATE SURGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6339 E SPEEDWAY BLVD STE 201
TUCSON AZ
85710-1147
US

IV. Provider business mailing address

6339 E SPEEDWAY BLVD STE 201
TUCSON AZ
85710-1147
US

V. Phone/Fax

Practice location:
  • Phone: 520-323-8732
  • Fax: 520-547-1865
Mailing address:
  • Phone: 520-323-8732
  • Fax: 520-547-1865

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: YVETTE RIVERA
Title or Position: REVENUE CYCLE MANAGER OF ABS
Credential:
Phone: 520-382-1291