MEDICARE: MESA SURGICAL 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

General Provider Information

NPI Number	:	1528284767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MESA SURGICAL CENTER, LLC

Provider Business Mailing Address
First Line	:	1114 SOUTH HIGLEY ROAD
Second Line	:	SUITE 101
City	:	MESA
State	:	AZ
Zip	:	85206-3000
Country	:	US
Telephone Number	:	480-485-4760
Fax Number	:	480-807-3633

Provider Business Practice Location Address
First Line	:	1114 SOUTH HIGLEY ROAD
Second Line	:	SUITE 101
City	:	MESA
State	:	AZ
Zip	:	85206-3000
Country	:	US
Telephone Number	:	480-485-4760
Fax Number	:	480-807-3633

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. HECTOR REYES
Credential	:
Telephone Number	:	480-854-7600

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	08/28/2008

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