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General NPI Number Information
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NPI Number | 1376096776
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Entity Type | Organization
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Legal Business Name | REPRO SURGICAL, LLC
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Dates
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Enumeration Date | 08/02/2016
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Last Update Date | 12/04/2017
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Provider Practice Location Address
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Address Line | 8415 N PIMA RD SUITE 291
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4480
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Country | US
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Telephone | 919-641-6024
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Fax | 480-434-6572
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Provider Business Mailing Address
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Address Line | 8415 N PIMA RD SUITE 291
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4480
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Country | US
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Telephone | 919-641-6024
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Fax | 480-434-6572
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MILLIE BEHERA
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Credential | M.D.
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Telephone | 919-641-6024
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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 | 42873
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License Number State | AZ
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