MEDICARE: JDS SURGICAL 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	:	1427664515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JDS SURGICAL LLC

Provider Business Mailing Address
First Line	:	5281 N 99TH AVE STE 100
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85305-2209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17500 N PERIMETER DR # 200
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-7800
Country	:	US
Telephone Number	:	623-742-1570
Fax Number	:

Authorized Official
Title or Position	:	ORGANIZER
Name	:	STEVEN M SIWEK
Credential	:
Telephone Number	:	623-742-1570

Provider Enumeration Date	:	09/23/2020
Last Update Date	:	05/06/2024

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