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General NPI Number Information
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NPI Number | 1740370501
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Entity Type | Organization
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Legal Business Name | SUMMIT SURGERY AND RECOVERY CARE CENTER INC
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 04/03/2012
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Provider Practice Location Address
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Address Line | 1485 N TURQUOISE DR SUITE 100
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-1397
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Country | US
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Telephone | 928-774-7757
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Fax | 928-774-7767
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Provider Business Mailing Address
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Address Line | 1485 N TURQUOISE DR SUITE 100
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-1398
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Country | US
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Telephone | 928-774-7757
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Fax | 928-774-7767
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Authorized Official
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Title or Position | CEO
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Name | THOMAS L POTTS
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Credential |
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Telephone | 928-774-7757
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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 | OSC0056
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License Number State | AZ
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