Provider Demographics
NPI:1104894369
Name:VALLEY OUTPATIENT SURGICAL CENTER INC
Entity type:Organization
Organization Name:VALLEY OUTPATIENT SURGICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SANFORD
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORETSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-833-0014
Mailing Address - Street 1:160 W UNIVERSITY
Mailing Address - Street 2:STE 1
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201
Mailing Address - Country:US
Mailing Address - Phone:480-835-7373
Mailing Address - Fax:480-835-6821
Practice Address - Street 1:160 W UNIVERSITY
Practice Address - Street 2:STE 1
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201
Practice Address - Country:US
Practice Address - Phone:480-835-7373
Practice Address - Fax:480-835-6821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC0034261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z3C0001044Medicare ID - Type Unspecified