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General NPI Number Information
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NPI Number | 1851531248
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Entity Type | Organization
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Legal Business Name | LASER SURGERY HOLDING COMPANY, LTD
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Dates
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Enumeration Date | 02/25/2009
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Last Update Date | 07/02/2014
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Provider Practice Location Address
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Address Line | 10255 N 32ND ST
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City | PHOENIX
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State | AZ
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Zip | 85028-3851
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Country | US
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Telephone | 602-258-7003
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Fax | 602-254-3474
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Provider Business Mailing Address
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Address Line | 10255 N 32ND ST
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City | PHOENIX
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State | AZ
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Zip | 85028-3851
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Country | US
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Telephone | 602-258-7003
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Fax | 602-254-3474
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | PETER THOMAS
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Credential | M.D.
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Telephone | 602-258-7003
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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 | OSC4560
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License Number State | AZ
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