Basic Information
| Provider Information | |||||||||
| NPI: | 1013105915 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LUNA SURGERY CENTER OF PHOENIX, AZ, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2501 N 32ND ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850082104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029576799 | ||||||||
| FaxNumber: | 6029570172 | ||||||||
| Practice Location | |||||||||
| Address1: | 2501 N 32ND ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850082104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029576799 | ||||||||
| FaxNumber: | 6029570172 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2007 | ||||||||
| LastUpdateDate: | 10/05/2007 | ||||||||
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| AuthorizedOfficialLastName: | CAMERON | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATIVE | ||||||||
| AuthorizedOfficialTelephone: | 2485539800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.