Provider Demographics
NPI:1396528709
Name:PRIME SURGICAL CENTER OF MESA, LLC
Entity type:Organization
Organization Name:PRIME SURGICAL CENTER OF MESA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGER
Authorized Official - Suffix:
Authorized Official - Credentials:CASC
Authorized Official - Phone:949-903-3210
Mailing Address - Street 1:550 N BRAND BLVD STE 900
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-4721
Mailing Address - Country:US
Mailing Address - Phone:818-937-9969
Mailing Address - Fax:
Practice Address - Street 1:6309 E BAYWOOD AVE STE 106
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1726
Practice Address - Country:US
Practice Address - Phone:818-937-9969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical