Basic Information
| Provider Information | |||||||||
| NPI: | 1669668281 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YUMA REGIONAL OUTPATIENT SURGICAL CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 27340 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850617340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029439200 | ||||||||
| FaxNumber: | 6022163026 | ||||||||
| Practice Location | |||||||||
| Address1: | 2261 S AVENUE B | ||||||||
| Address2: | |||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853646103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283432180 | ||||||||
| FaxNumber: | 9283730754 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2007 | ||||||||
| LastUpdateDate: | 06/23/2011 | ||||||||
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| AuthorizedOfficialLastName: | WALZ | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE CHAIRMAN | ||||||||
| AuthorizedOfficialTelephone: | 9283447275 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | AZ | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.