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General NPI Number Information
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NPI Number | 1720244973
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Entity Type | Organization
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Legal Business Name | INDEPENDENT SURGEONS PC
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Dates
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Enumeration Date | 08/06/2008
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Last Update Date | 08/12/2010
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Provider Practice Location Address
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Address Line | 19424 N R H JOHNSON BLVD ST 101
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City | SUN CITY WEST
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State | AZ
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Zip | 85375-1409
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Country | US
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Telephone | 602-568-7114
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 39179
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City | PHOENIX
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State | AZ
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Zip | 85069-9179
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Country | US
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Telephone | 602-395-0718
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Fax | 602-277-8146
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Authorized Official
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Title or Position | CREDENTIALING
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Name | SHANNON WHITE
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Credential |
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Telephone | 602-395-0718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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