MEDICARE: SURGICAL SPECIALTY HOSPITAL 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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center
2	284300000X	Special Hospital

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	:	1902881295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL SPECIALTY HOSPITAL OF ARIZONA, LLC

Provider Business Mailing Address
First Line	:	6501 N 19TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-1646
Country	:	US
Telephone Number	:	602-795-6020
Fax Number	:	602-795-6022

Provider Business Practice Location Address
First Line	:	6501 N 19TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-1646
Country	:	US
Telephone Number	:	602-795-6020
Fax Number	:	602-795-6022

Authorized Official
Title or Position	:	CHIEF OF ADMINISTRATION & STAFF OFF
Name	:	ERIC TOMLON
Credential	:
Telephone Number	:	623-537-5605

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	04/17/2025

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