Provider Demographics
NPI:1285767822
Name:ARIZONA SURGICAL SPECIALISTS CENTER, LLC
Entity type:Organization
Organization Name:ARIZONA SURGICAL SPECIALISTS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIWEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-516-8252
Mailing Address - Street 1:5281 N 99TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-3105
Mailing Address - Country:US
Mailing Address - Phone:480-237-1234
Mailing Address - Fax:623-691-8502
Practice Address - Street 1:1984 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1535
Practice Address - Country:US
Practice Address - Phone:480-237-1234
Practice Address - Fax:480-237-1236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC6456261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ940727OtherAHCCCS NUMBER
AZZ102423Medicare PIN
AZ940727OtherAHCCCS NUMBER