=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609057017
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AHWATUKEE SURGERY CENTER, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2007
-----------------------------------------------------
Last Update Date | 04/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15810 S 45TH ST STE 150
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85048-7655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-759-1554
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15810 S 45TH ST STE 150
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85048-7655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. TODD FARNWORTH
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 480-759-1554
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------