=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235656174
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VINCERE SURGERY CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2017
-----------------------------------------------------
Last Update Date | 03/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7469 E MONTE CRISTO AVE
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260-1618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-331-7811
-----------------------------------------------------
Fax | 602-331-5886
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 207438
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75320-7433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-625-0003
-----------------------------------------------------
Fax | 480-842-8760
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | PABLO PRICHARD
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 480-625-0003
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QX0200X
-----------------------------------------------------
Taxonomy Name | Oncology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------