=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538126065
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARNET DULANEY SURGERY CENTERS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2006
-----------------------------------------------------
Last Update Date | 09/14/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4800 N 22ND ST
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85016-4701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-955-1000
-----------------------------------------------------
Fax | 602-508-4830
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4800 N 22ND ST
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85016-4701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-955-1000
-----------------------------------------------------
Fax | 602-508-4830
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SURGICAL ADMINISTRATOR
-----------------------------------------------------
Name | MS. IMELDA KELLY
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 602-955-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | OSC4190
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------