Provider Demographics
NPI:1720305535
Name:ARIZONA SURGEONS ASSISTANT PC
Entity type:Organization
Organization Name:ARIZONA SURGEONS ASSISTANT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HAITHAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:602-568-7294
Mailing Address - Street 1:4369 E HARTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2298
Mailing Address - Country:US
Mailing Address - Phone:602-568-7294
Mailing Address - Fax:602-867-4992
Practice Address - Street 1:4369 E HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2298
Practice Address - Country:US
Practice Address - Phone:602-568-7294
Practice Address - Fax:602-867-4992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1013800363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1922OtherAZ MEDICAL BOARD
AZZ138269OtherMEDICARE PTAN
AZZ138269OtherMEDICARE PTAN
AZZ138269Medicare PIN