Basic Information
| Provider Information | |||||||||
| NPI: | 1265848105 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARIZONA SURGICAL ASSISTANTS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8424 E SHEA BLVD | ||||||||
| Address2: | #101 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852606662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802561518 | ||||||||
| FaxNumber: | 4804786628 | ||||||||
| Practice Location | |||||||||
| Address1: | 5555 W THUNDERBIRD RD | ||||||||
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| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853064622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238655555 | ||||||||
| FaxNumber: | 4804786628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2014 | ||||||||
| LastUpdateDate: | 12/19/2014 | ||||||||
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| AuthorizedOfficialLastName: | MITCHELL | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4802561518 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PA-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 3740 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.