Basic Information
| Provider Information | |||||||||
| NPI: | 1104894369 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY OUTPATIENT SURGICAL CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 160 W UNIVERSITY | ||||||||
| Address2: | STE 1 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808357373 | ||||||||
| FaxNumber: | 4808356821 | ||||||||
| Practice Location | |||||||||
| Address1: | 160 W UNIVERSITY | ||||||||
| Address2: | STE 1 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808357373 | ||||||||
| FaxNumber: | 4808356821 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MORETSKY | ||||||||
| AuthorizedOfficialFirstName: | SANFORD | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 4808330014 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | OSC0034 | AZ | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.