=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285407304
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SURGERY CENTERS OF ARIZONA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2023
-----------------------------------------------------
Last Update Date | 10/31/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14287 N 87TH STREET, SUITE 220
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-551-4942
-----------------------------------------------------
Fax | 480-661-2158
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14287 N 87TH STREET, SUITE 220
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-551-4942
-----------------------------------------------------
Fax | 480-661-2158
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER/OWNER
-----------------------------------------------------
Name | TIMOTHY A SPOONER
-----------------------------------------------------
Credential | PT, FAFS
-----------------------------------------------------
Telephone | 480-551-4942
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------