MEDICARE: OUTPATIENT SURGICAL CENTER OF ARIZONA, 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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1619739554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUTPATIENT SURGICAL CENTER OF ARIZONA, LLC

Provider Business Mailing Address
First Line	:	13215 N 7TH ST STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-5300
Country	:	US
Telephone Number	:	602-805-5041
Fax Number	:

Provider Business Practice Location Address
First Line	:	13215 N 7TH ST STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-5300
Country	:	US
Telephone Number	:	602-805-5041
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND PHYSICIAN
Name	:	BRIAN F GRUBER
Credential	:
Telephone Number	:	602-805-5041

Provider Enumeration Date	:	01/25/2024
Last Update Date	:	01/26/2024

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