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General NPI Number Information
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NPI Number | 1649710328
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Entity Type | Organization
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Legal Business Name | CITY OF SURPRISE
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Dates
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Enumeration Date | 03/01/2017
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Last Update Date | 03/15/2021
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Provider Practice Location Address
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Address Line | 14250 W STATLER PLZ STE 101
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City | SURPRISE
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State | AZ
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Zip | 85374-7474
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Country | US
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Telephone | 623-222-5000
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Fax |
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Provider Business Mailing Address
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Address Line | DEPT #880156 PO BOX 29650
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City | PHOENIX
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State | AZ
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Zip | 85038-9650
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Country | US
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Telephone | 623-222-1000
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Fax | 623-222-5001
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Authorized Official
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Title or Position | DIRECTOR
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Name | TOM ABBOTT
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Credential |
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Telephone | 623-222-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | TRN: 17-002
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License Number State | AZ
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