MEDICARE: RAAD TAKI SURGERY CENTER

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	174400000X	Specialist	AZ 27306	AZ

General Provider Information

NPI Number	:	1760513824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAAD TAKI SURGERY CENTER

Provider Business Mailing Address
First Line	:	4580 E CAMP LOWELL DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1282
Country	:	US
Telephone Number	:	520-881-3232
Fax Number	:	520-881-3535

Provider Business Practice Location Address
First Line	:	4580 E CAMP LOWELL DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1282
Country	:	US
Telephone Number	:	520-881-3232
Fax Number	:	520-881-3535

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LYNN GROBERG
Credential	:	RN
Telephone Number	:	520-881-3232

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	08/22/2020

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Directions to “RAAD TAKI SURGERY CENTER ” Practice Location

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