MEDICARE: CLINICIS PHOENIX SURGERY CENTER, LLC

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	OSC 3640	AZ
2	261QP3300X	Pain Clinic/Center	OSC 3640	AZ

General Provider Information

NPI Number	:	1184621328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICIS PHOENIX SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 29211
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85038-9211
Country	:	US
Telephone Number	:	602-273-6770
Fax Number	:	602-889-0489

Provider Business Practice Location Address
First Line	:	7725 N 43RD AVE
Second Line	:	510
City	:	PHOENIX
State	:	AZ
Zip	:	85051-5770
Country	:	US
Telephone Number	:	602-273-6770
Fax Number	:	602-889-0489

Authorized Official
Title or Position	:	MANAGER
Name	:	CYNTHIA DUBRABCAK
Credential	:
Telephone Number	:	602-273-6770

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	09/11/2025

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