Basic Information
| Provider Information | |||||||||
| NPI: | 1821471913 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARIZONA SURGICAL SPECIALISTS CENTER, LLC | ||||||||
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| OtherOrganizationName: | ARIZONA SURGICAL SPECIALSTS CENTER WEST PHOENIX | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5281 N 99TH AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853053105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235168252 | ||||||||
| FaxNumber: | 6235168253 | ||||||||
| Practice Location | |||||||||
| Address1: | 9250 W THOMAS RD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850373382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235168252 | ||||||||
| FaxNumber: | 6235168253 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2015 | ||||||||
| LastUpdateDate: | 02/02/2019 | ||||||||
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| AuthorizedOfficialLastName: | SIWEK | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6235168252 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ARIZONA SURGICAL SPECIALISTS CENTER LLC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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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.