MEDICARE: MISSCPV HOLDINGS, 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	:	1992665772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSCPV HOLDINGS, LLC

Provider Business Mailing Address
First Line	:	3135 E LINCOLN DR STE A
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-2301
Country	:	US
Telephone Number	:	602-349-5040
Fax Number	:	602-666-3031

Provider Business Practice Location Address
First Line	:	3135 E LINCOLN DR STE A
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-2301
Country	:	US
Telephone Number	:	602-349-5040
Fax Number	:	602-666-3031

Authorized Official
Title or Position	:	CEO
Name	:	JOSHUA HUFSTEDT
Credential	:	MD
Telephone Number	:	602-349-5040

Provider Enumeration Date	:	11/14/2025
Last Update Date	:	11/14/2025

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