Healthcare Provider Details

I. General information

NPI: 1811228083
Provider Name (Legal Business Name): MESQUITE SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7445 E TANQUE VERDE RD
TUCSON AZ
85715-3477
US

IV. Provider business mailing address

7445 E TANQUE VERDE RD
TUCSON AZ
85715-3477
US

V. Phone/Fax

Practice location:
  • Phone: 520-722-0929
  • Fax: 520-722-0930
Mailing address:
  • Phone: 520-722-0929
  • Fax: 520-722-0930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberOSC4905
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHERINE WILKES BELK-ARENAS
Title or Position: ADMINISTRATOR
Credential:
Phone: 520-722-0744