Provider Demographics
NPI:1396174454
Name:SURGERY CENTER OF SCOTTSDALE LLC
Entity type:Organization
Organization Name:SURGERY CENTER OF SCOTTSDALE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-567-0269
Mailing Address - Street 1:18555 N 79TH AVE
Mailing Address - Street 2:BLDG C
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8370
Mailing Address - Country:US
Mailing Address - Phone:623-776-2500
Mailing Address - Fax:623-776-2555
Practice Address - Street 1:18555 N 79TH AVE
Practice Address - Street 2:BLDG C
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8370
Practice Address - Country:US
Practice Address - Phone:623-776-2500
Practice Address - Fax:623-776-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC6638261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ163581Medicare PIN