Provider Demographics
NPI:1972193555
Name:SELECT SURGICAL LLC
Entity type:Organization
Organization Name:SELECT SURGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA-C/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:480-600-6849
Mailing Address - Street 1:1776 N SCOTTSDALE RD # 368
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85252
Mailing Address - Country:US
Mailing Address - Phone:480-201-5264
Mailing Address - Fax:480-393-1970
Practice Address - Street 1:1776 N SCOTTSDALE RD # 368
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85252
Practice Address - Country:US
Practice Address - Phone:480-201-5264
Practice Address - Fax:480-393-1970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty