MEDICARE: AZ WEST ENDOSCOPY 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790093813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AZ WEST ENDOSCOPY CENTER LLC

Provider Business Mailing Address
First Line	:	1850 N 95TH AVE
Second Line	:	SUITE 190
City	:	PHOENIX
State	:	AZ
Zip	:	85037-4317
Country	:	US
Telephone Number	:	623-594-4060
Fax Number	:	623-594-8736

Provider Business Practice Location Address
First Line	:	1850 N 95TH AVE
Second Line	:	SUITE 190
City	:	PHOENIX
State	:	AZ
Zip	:	85037-4317
Country	:	US
Telephone Number	:	623-594-4060
Fax Number	:	623-594-8736

Authorized Official
Title or Position	:	TREASURER
Name	:	KAREN P SABLYAK
Credential	:
Telephone Number	:	215-589-9001

Provider Enumeration Date	:	09/23/2010
Last Update Date	:	02/04/2015

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