Basic Information
| Provider Information | |||||||||
| NPI: | 1316007420 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PALMER SURGICENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6740 W DEER VALLEY RD | ||||||||
| Address2: | SUITE D107-255 | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853105953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022982653 | ||||||||
| FaxNumber: | 6022982686 | ||||||||
| Practice Location | |||||||||
| Address1: | 2699 STIRLING RD | ||||||||
| Address2: | #B101 | ||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333126517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549895001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 06/25/2010 | ||||||||
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| AuthorizedOfficialLastName: | PALMER | ||||||||
| AuthorizedOfficialFirstName: | RUSSEL | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6022982653 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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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.