MEDICARE: DOCTORS OUTPATIENT SURGICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	OSC4604	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	03-C0001321	OTHER	AZ	CMS CERTIFICATION

General Provider Information

NPI Number	:	1144465410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOCTORS OUTPATIENT SURGICAL CENTER

Provider Business Mailing Address
First Line	:	2155 E CONFERENCE DR
Second Line	:	SUITE 111
City	:	TEMPE
State	:	AZ
Zip	:	85284
Country	:	US
Telephone Number	:	480-839-2020
Fax Number	:	480-839-2121

Provider Business Practice Location Address
First Line	:	2155 E CONFERENCE DR
Second Line	:	SUITE 111
City	:	TEMPE
State	:	AZ
Zip	:	85284-2604
Country	:	US
Telephone Number	:	480-839-2020
Fax Number	:	480-839-2121

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DR. BEN C EUBANK
Credential	:	DC
Telephone Number	:	480-839-2020

Provider Enumeration Date	:	12/15/2008
Last Update Date	:	10/26/2016

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Directions to “DOCTORS OUTPATIENT SURGICAL CENTER ” Practice Location

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