MEDICARE: OA WEST VALLEY SURGICAL PARTNERS 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

General Provider Information

NPI Number	:	1255265195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OA WEST VALLEY SURGICAL PARTNERS LLC

Provider Business Mailing Address
First Line	:	9070 W GLENDALE AVE STE 110
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85305-1120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9070 W GLENDALE AVE STE 110
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85305-1120
Country	:	US
Telephone Number	:	623-266-7788
Fax Number	:	623-321-9517

Authorized Official
Title or Position	:	EVP CHIEF FINANCIAL OFFICER
Name	:	JAY MCKIM
Credential	:
Telephone Number	:	949-680-3443

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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