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NPI Code Detail

MEDICARE: SURGCENTER NORTHERN PHOENIX LLC

MEDICARE: SURGCENTER NORTHERN PHOENIX 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
1261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1265009005
Entity Type Code : Organization
Provider Name (Legal Business Name) : SURGCENTER NORTHERN PHOENIX LLC
Provider Business Mailing Address
First Line : 18 ROAD 3336
Second Line :
City : AZTEC
State : NM
Zip : 87410-9101
Country : US
Telephone Number : 435-757-8894
Fax Number :
Provider Business Practice Location Address
First Line : 2611 W CAREFREE HWY BLDG E
Second Line :
City : PHOENIX
State : AZ
Zip : 85085-8862
Country : US
Telephone Number : 143-575-7889
Fax Number :
Authorized Official
Title or Position : CEO
Name : KEVEN BURNS
Credential : MD
Telephone Number : 480-747-1321
Provider Enumeration Date : 06/09/2021
Last Update Date : 02/05/2024

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Directions to “SURGCENTER NORTHERN PHOENIX LLC ” Practice Location

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