MEDICARE: TCSC EV 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	:	1417479635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TCSC EV LLC

Provider Business Mailing Address
First Line	:	1114 S HIGLEY RD STE 101-A
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-3000
Country	:	US
Telephone Number	:	602-715-1654
Fax Number	:

Provider Business Practice Location Address
First Line	:	1114 S HIGLEY RD STE 101
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-3000
Country	:	US
Telephone Number	:	602-715-1654
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	WAYNE DESTEFANO
Credential	:
Telephone Number	:	602-715-1657

Provider Enumeration Date	:	07/10/2017
Last Update Date	:	07/21/2022

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Directions to “TCSC EV LLC ” Practice Location

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