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General NPI Number Information
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NPI Number | 1184894768
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Entity Type | Organization
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Legal Business Name | SURGENCY PHYSICIAN ASSISTANT PLLC
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 07/03/2008
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Provider Practice Location Address
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Address Line | 3145 E CHANDLER BLVD # 110-207
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City | PHOENIX
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State | AZ
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Zip | 85048-8702
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Country | US
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Telephone | 602-615-9082
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Fax |
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Provider Business Mailing Address
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Address Line | 3145 E CHANDLER BLVD # 110-207
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City | PHOENIX
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State | AZ
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Zip | 85048-8702
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Country | US
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Telephone | 602-615-9082
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAULA RICHARDSON
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Credential | PA-C
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Telephone | 602-615-9082
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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 |
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License Number State |
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