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General NPI Number Information
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NPI Number | 1104418771
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Entity Type | Organization
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Legal Business Name | MARYVALE SURGERY CENTER, LLC
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Dates
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Enumeration Date | 02/05/2021
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Last Update Date | 02/05/2021
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Provider Practice Location Address
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Address Line | 7141 W THOMAS RD STE 101
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City | PHOENIX
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State | AZ
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Zip | 85033-5518
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Country | US
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Telephone | 602-549-2225
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Fax |
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Provider Business Mailing Address
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Address Line | 604 W WARNER RD STE C2
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City | CHANDLER
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State | AZ
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Zip | 85225-2915
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Country | US
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Telephone | 602-549-2225
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | ALEX BIGHAM
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Credential | DC
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Telephone | 602-549-2225
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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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