Basic Information
| Provider Information | |||||||||
| NPI: | 1184621328 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CLINICIS PHOENIX SURGERY CENTER, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CLINICIS PAIN MANAGEMENT & OUTPATIENT SURGERY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 29211 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850389211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022736770 | ||||||||
| FaxNumber: | 6028890489 | ||||||||
| Practice Location | |||||||||
| Address1: | 7725 N 43RD AVE | ||||||||
| Address2: | 510 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850515770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022736770 | ||||||||
| FaxNumber: | 6028890489 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DUBRABCAK | ||||||||
| AuthorizedOfficialFirstName: | CYNTHIA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6022736770 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | OSC 3640 | AZ | X | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | 261QP3300X | OSC 3640 | AZ | X | Ambulatory Health Care Facilities | Clinic/Center | Pain |
No ID Information.