Provider Demographics
NPI:1528284767
Name:MESA SURGICAL CENTER, LLC
Entity type:Organization
Organization Name:MESA SURGICAL CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-854-7600
Mailing Address - Street 1:1114 SOUTH HIGLEY ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3000
Mailing Address - Country:US
Mailing Address - Phone:480-485-4760
Mailing Address - Fax:480-807-3633
Practice Address - Street 1:1114 SOUTH HIGLEY ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3000
Practice Address - Country:US
Practice Address - Phone:480-485-4760
Practice Address - Fax:480-807-3633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical