Provider Demographics
NPI:1285053702
Name:PRECISION SURGICAL LLC
Entity type:Organization
Organization Name:PRECISION SURGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHAMBERLAIN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:602-559-9310
Mailing Address - Street 1:8776 E SHEA BLVD
Mailing Address - Street 2:STE 106-610
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6687
Mailing Address - Country:US
Mailing Address - Phone:602-559-9310
Mailing Address - Fax:602-559-9311
Practice Address - Street 1:4250 E CAMELBACK RD
Practice Address - Street 2:STE K105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-8301
Practice Address - Country:US
Practice Address - Phone:602-559-9310
Practice Address - Fax:602-559-9311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-11
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22292174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ314914Medicaid
AZF83041Medicare UPIN
AZ314914Medicaid