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General NPI Number Information
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NPI Number | 1942624622
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Entity Type | Organization
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Legal Business Name | OLIVE SURGICAL CARE, LLC
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Dates
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Enumeration Date | 02/14/2014
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Last Update Date | 04/02/2015
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Provider Practice Location Address
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Address Line | 8914 N 91ST AVE SUITE 100-A
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City | PEORIA
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State | AZ
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Zip | 85345-8396
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Country | US
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Telephone | 623-547-5420
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Fax | 623-594-8936
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Provider Business Mailing Address
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Address Line | 8914 N 91ST AVE SUITE 100-A
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City | PEORIA
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State | AZ
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Zip | 85345-8396
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Country | US
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Telephone | 623-547-5420
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Fax | 623-594-8936
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | AARON LATOWSKY
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Credential | MD
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Telephone | 623-547-5420
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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 | OSC5845
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License Number State | AZ
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