Provider Demographics
NPI:1215975966
Name:JCL SURGERY, LLC
Entity type:Organization
Organization Name:JCL SURGERY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:GROVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-216-6687
Mailing Address - Street 1:3201 W PEORIA AVE
Mailing Address - Street 2:SUITE C500
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4608
Mailing Address - Country:US
Mailing Address - Phone:602-298-6516
Mailing Address - Fax:602-298-2347
Practice Address - Street 1:3201 W PEORIA AVE
Practice Address - Street 2:SUITE C500
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4608
Practice Address - Country:US
Practice Address - Phone:602-298-6516
Practice Address - Fax:602-298-2347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ093479Medicaid
108562Medicare ID - Type UnspecifiedCHRIS SALVINO MD
AZ093479Medicaid
I37532Medicare UPIN
AZ882143Medicare ID - Type UnspecifiedCHRIS SALVINO MD
109125Medicare ID - Type UnspecifiedKUMASH PATEL MD
AZZ108488Medicare PIN