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General NPI Number Information
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NPI Number | 1134053085
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Entity Type | Organization
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Legal Business Name | PEORIA STADIUM CREEK ASC LLC
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Dates
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Enumeration Date | 06/08/2026
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Last Update Date | 06/08/2026
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Provider Practice Location Address
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Address Line | 15000 N 83RD AVE, SUITE 105
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City | PEORIA
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State | AZ
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Zip | 85381-2001
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Country | US
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Telephone | 623-266-1919
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Fax | 623-321-9948
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Provider Business Mailing Address
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Address Line | 15000 N 83RD AVE, SUITE 105
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City | PEORIA
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State | AZ
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Zip | 85381-2001
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Country | US
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Telephone | 623-266-1919
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Fax | 623-321-9948
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Authorized Official
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Title or Position | EVP CHIEF FINANCIAL OFFICER
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Name | JAY MCKIM
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Credential |
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Telephone | 949-680-3443
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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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