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General NPI Number Information
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NPI Number | 1124669585
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Entity Type | Organization
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Legal Business Name | ADVANCED SURGERY CENTER CONSULTANTS, LLC
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Dates
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Enumeration Date | 10/07/2019
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Last Update Date | 10/07/2019
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Provider Practice Location Address
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Address Line | 15333 N PIMA RD STE 305
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-2717
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Country | US
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Telephone | 808-546-9864
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Fax |
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Provider Business Mailing Address
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Address Line | 21211 N 38TH PL
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City | PHOENIX
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State | AZ
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Zip | 85050-4963
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JONATHAN CARLSON
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Credential | MD
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Telephone | 808-546-9864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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