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General NPI Number Information
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NPI Number | 1063386332
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Entity Type | Organization
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Legal Business Name | PHANTOM SURGICAL LLC
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Dates
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Enumeration Date | 09/30/2025
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 19820 N 7TH ST STE 208
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City | PHOENIX
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State | AZ
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Zip | 85024-1694
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Country | US
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Telephone | 480-773-1803
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 41340
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City | PHOENIX
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State | AZ
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Zip | 85080-1340
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Country | US
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Telephone | 480-773-1803
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | BRETT MCLAUGHLIN
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Credential |
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Telephone | 480-773-1803
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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 |
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