Healthcare Provider Details

I. General information

NPI: 1861852972
Provider Name (Legal Business Name): NM SURGICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

6339 E SPEEDWAY BLVD SUITE 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 TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QL0400X
TaxonomyLithotripsy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW GLEASON
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 520-547-4115