=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801146535
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SURGCENTER AT PARADISE VALLEY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2012
-----------------------------------------------------
Last Update Date | 01/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8415 N PIMA RD SUITE 190
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-800-3200
-----------------------------------------------------
Fax | 480-800-3219
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8415 N PIMA RD SUITE 190
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-800-3800
-----------------------------------------------------
Fax | 480-800-3219
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICER/AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | ERIC BOON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 480-567-0269
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------