1154326650 NPI number — SCOTTSDALE SURGICAL PARTNERS LLC

Table of content: (NPI 1154326650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154326650 NPI number — SCOTTSDALE SURGICAL PARTNERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCOTTSDALE SURGICAL PARTNERS LLC
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:
NORTH VALLEY SURGERY CENTER
Provider Other Organization Name Type Code:
3
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:
1154326650
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3033 N. 44TH ST.
Provider Second Line Business Mailing Address:
SUITE 330
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-207-3716
Provider Business Mailing Address Fax Number:
623-266-0053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8901 E. RAINTREE DR.
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-767-2100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GIESSLER
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF OPERATIONS
Authorized Official Telephone Number:
480-207-3716

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM1300X , with the licence number: OSC3774 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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