Basic Information
| Provider Information | |||||||||
| NPI: | 1023567260 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SKI AMBULATORY SURGICAL CENTERS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7362 W THUNDERBIRD RD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853815028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806106152 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7362 W THUNDERBIRD RD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853815028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806106152 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2016 | ||||||||
| LastUpdateDate: | 02/14/2017 | ||||||||
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| AuthorizedOfficialLastName: | WAHEED | ||||||||
| AuthorizedOfficialFirstName: | UMAR | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR / MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 4806106152 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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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.