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General NPI Number Information
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NPI Number | 1265009005
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Entity Type | Organization
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Legal Business Name | SURGCENTER NORTHERN PHOENIX LLC
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Dates
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Enumeration Date | 06/09/2021
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 2611 W CAREFREE HWY BLDG E
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City | PHOENIX
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State | AZ
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Zip | 85085-8862
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Country | US
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Telephone | 143-575-7889
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Fax |
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Provider Business Mailing Address
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Address Line | 18 ROAD 3336
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City | AZTEC
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State | NM
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Zip | 87410-9101
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Country | US
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Telephone | 435-757-8894
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KEVEN BURNS
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Credential | MD
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Telephone | 480-747-1321
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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 |
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License Number State |
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