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General NPI Number Information
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NPI Number | 1245613256
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Entity Type | Organization
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Legal Business Name | PARADISE VALLEY SURGERY CENTER
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Dates
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Enumeration Date | 07/08/2015
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Last Update Date | 07/08/2015
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Provider Practice Location Address
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Address Line | 1008 E MCDOWELL RD SUITE C
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City | PHOENIX
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State | AZ
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Zip | 85006-2603
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Country | US
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Telephone | 602-254-6369
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Fax |
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Provider Business Mailing Address
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Address Line | 4400 N SCOTTSDALE RD SUITE 9, #98
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-3331
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Country | US
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Telephone | 602-254-6369
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Fax | 602-254-6372
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | BILAL SHANTI
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Credential | M.D.
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Telephone | 602-254-6369
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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 | OSC7168
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License Number State | AZ
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