Provider Demographics
NPI:1841842747
Name:SCOTTSDALE OUTPATIENT SURGERY
Entity type:Organization
Organization Name:SCOTTSDALE OUTPATIENT SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-510-3203
Mailing Address - Street 1:8994 E DESERT COVE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-7901
Mailing Address - Country:US
Mailing Address - Phone:602-510-3203
Mailing Address - Fax:602-297-6997
Practice Address - Street 1:8994 E DESERT COVE AVE STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-7901
Practice Address - Country:US
Practice Address - Phone:602-510-3203
Practice Address - Fax:602-297-6997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty