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General NPI Number Information
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NPI Number | 1699777540
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Entity Type | Organization
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Legal Business Name | PHYSICIANS SURGERY CENTER OF TEMPE, LLC
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 1940 E SOUTHERN AVE
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City | TEMPE
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State | AZ
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Zip | 85282
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Country | US
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Telephone | 480-820-7101
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Fax | 480-820-9291
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Provider Business Mailing Address
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Address Line | 14201 DALLAS PKWY
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City | DALLAS
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State | TX
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Zip | 75254-2916
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Country | US
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Telephone | 727-633-8939
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Fax |
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Authorized Official
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Title or Position | OFFICER, AUTHORIZED OFFICIAL
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Name | ERIC BOON
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Credential |
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Telephone | 480-567-0269
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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 | OSC0043
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License Number State | AZ
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