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General NPI Number Information
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NPI Number | 1154378909
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Entity Type | Organization
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Legal Business Name | AMBULATORY SURGI-CENTER AT FMC LLC
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 06/11/2010
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Provider Practice Location Address
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Address Line | 1200 N BEAVER ST STE B
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3118
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Country | US
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Telephone | 928-214-2700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2730
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City | FLAGSTAFF
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State | AZ
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Zip | 86003-2730
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Country | US
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Telephone | 928-214-2700
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SUSAN NOVAK
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Credential |
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Telephone | 928-214-2700
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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 | OSC 2303
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License Number State | AZ
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