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General NPI Number Information
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NPI Number | 1164821112
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Entity Type | Organization
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Legal Business Name | ARIZONA SURGICAL ASSOCIATES, PLC
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Dates
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Enumeration Date | 08/15/2014
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Last Update Date | 08/30/2019
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Provider Practice Location Address
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Address Line | 9305 W THOMAS RD STE 480
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City | PHOENIX
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State | AZ
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Zip | 85037-3375
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Country | US
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Telephone | 480-829-6100
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Fax | 480-446-9475
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Provider Business Mailing Address
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Address Line | 1855 E SOUTHERN AVE BLDG A
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City | TEMPE
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State | AZ
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Zip | 85282-5894
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Country | US
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Telephone | 480-829-6100
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | BENJAMIN MOORE
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Credential |
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Telephone | 480-829-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 006189
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License Number State | AZ
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