Healthcare Provider Details

I. General information

NPI: 1629133442
Provider Name (Legal Business Name): ARIZONA SURGICAL ARTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 N. WILMOT ROAD
TUCSON AZ
85712
US

IV. Provider business mailing address

1245 N. WILMOT ROAD
TUCSON AZ
85712
US

V. Phone/Fax

Practice location:
  • Phone: 520-722-0909
  • Fax: 520-722-6937
Mailing address:
  • Phone: 520-722-0909
  • Fax: 520-722-6937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberOSC-0054
License Number StateAZ

VIII. Authorized Official

Name: MR. ROBERT M. DRYDEN
Title or Position: ADMINISTRATOR
Credential: MD
Phone: 520-722-0909