Healthcare Provider Details

I. General information

NPI: 1437191731
Provider Name (Legal Business Name): EL DORADO SURGERY CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 N CRAYCROFT RD BLDG 8
TUCSON AZ
85712-2801
US

IV. Provider business mailing address

PO BOX 848236
DALLAS TX
75284-8236
US

V. Phone/Fax

Practice location:
  • Phone: 520-877-4254
  • Fax: 877-319-4035
Mailing address:
  • Phone: 520-877-4254
  • Fax: 877-319-4035

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: KRISTINA MUSIC
Title or Position: DIRECTOR OF PROVIDER ENROLLMENT
Credential:
Phone: 615-465-7377