Basic Information
| Provider Information | |||||||||
| NPI: | 1427664515 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JDS SURGICAL LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5281 N 99TH AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853052209 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 9250 W THOMAS RD STE 220 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850373382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6237421570 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2020 | ||||||||
| LastUpdateDate: | 09/23/2020 | ||||||||
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| AuthorizedOfficialLastName: | SIWEK | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | ORGANIZER | ||||||||
| AuthorizedOfficialTelephone: | 6237421570 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.