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General NPI Number Information
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NPI Number | 1134290893
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Entity Type | Organization
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Legal Business Name | TCS SURGICAL FACILITY, PC
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 19636 N 27TH AVE STE 206
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City | PHOENIX
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State | AZ
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Zip | 85027-4013
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Country | US
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Telephone | 623-516-1030
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Fax | 623-580-9084
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Provider Business Mailing Address
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Address Line | 19636 N 27TH AVE STE 206
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City | PHOENIX
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State | AZ
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Zip | 85027-4013
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Country | US
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Telephone | 623-516-1030
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Fax | 623-580-9084
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN SAMUAL TRAIKOVICH
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Credential | DO
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Telephone | 623-516-1030
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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 | 394718
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License Number State | AZ
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