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General NPI Number Information
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NPI Number | 1013310036
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Entity Type | Organization
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Legal Business Name | PHOENIX SURGERY CENTER LLC
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Dates
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Enumeration Date | 10/04/2014
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Last Update Date | 08/09/2016
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Provider Practice Location Address
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Address Line | 20045 N 19TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85027-4252
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Country | US
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Telephone | 888-678-8411
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Fax | 602-926-2736
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Provider Business Mailing Address
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Address Line | PO BOX 37050
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City | TUCSON
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State | AZ
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Zip | 85740-7050
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Country | US
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Telephone | 888-678-8411
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Fax | 602-926-2736
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Authorized Official
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Title or Position | PRESIDENT
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Name | LIMOR PHILIPP WALL
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Credential | MD
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Telephone | 888-678-8411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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