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General NPI Number Information
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NPI Number | 1023296381
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Entity Type | Organization
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Legal Business Name | ON-CALL SURGICAL ASSISTANTS LLC
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Dates
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Enumeration Date | 02/08/2008
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Last Update Date | 08/19/2019
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Provider Practice Location Address
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Address Line | 5710 W SPUR DR
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City | PHOENIX
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State | AZ
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Zip | 85083-1245
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Country | US
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Telephone | 623-229-4674
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 12546
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City | GLENDALE
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State | AZ
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Zip | 85318-2546
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Country | US
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Telephone | 623-229-4674
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT/ PRESIDENT
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Name | MR. TIMOTHY TROY HOLBERT
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Credential | PA-C
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Telephone | 623-229-4674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 2021
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License Number State | AZ
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