Healthcare Provider Details

I. General information

NPI: 1508438375
Provider Name (Legal Business Name): BSC REID PARK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 S ALVERNON WAY
TUCSON AZ
85711-5351
US

IV. Provider business mailing address

2355 E CAMELBACK RD STE 700
PHOENIX AZ
85016-9044
US

V. Phone/Fax

Practice location:
  • Phone: 520-204-1495
  • Fax:
Mailing address:
  • Phone:
  • 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: ARIC BURKE
Title or Position: DIRECTOR/OFFICER
Credential:
Phone: 480-689-8403