1144275025 NPI number — SURGICARE SHERIDAN SURGICAL SERVICES

Table of content: (NPI 1144275025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144275025 NPI number — SURGICARE SHERIDAN SURGICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICARE SHERIDAN SURGICAL SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144275025
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 51058
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85208-0053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-692-0362
Provider Business Mailing Address Fax Number:
480-354-7480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3035 S ELLSWORTH RD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85212-2160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-354-7478
Provider Business Practice Location Address Fax Number:
480-354-7480
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHERIDAN
Authorized Official First Name:
VALERIE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICE OWNER
Authorized Official Telephone Number:
866-692-0362

Provider Taxonomy Codes

  • Taxonomy code: 305R00000X , with the licence number:  3977 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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