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General NPI Number Information
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NPI Number | 1043750490
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Entity Type | Organization
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Legal Business Name | STANDARD SURGICAL LLC
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Dates
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Enumeration Date | 03/05/2017
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Last Update Date | 04/20/2018
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Provider Practice Location Address
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Address Line | 5115 N DYSART RD STE 202-197
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-3032
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Country | US
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Telephone | 801-647-5158
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 29650 DEPT 880187
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City | PHOENIX
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State | AZ
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Zip | 85038-9650
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Country | US
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Telephone | 801-647-5158
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | ELLIOT STEADMAN
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Credential |
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Telephone | 801-647-5158
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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 |
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License Number State | AZ
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