Provider Demographics
NPI:1902807159
Name:SURGERY CENTER OF SCOTTSDALE, LLC
Entity Type:Organization
Organization Name:SURGERY CENTER OF SCOTTSDALE, LLC
Other - Org Name:MOUNTAIN VIEW SURGERY CENTER OF SCOTTSDALE
Other - Org Type:Other Name
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-567-0269
Mailing Address - Street 1:8962 E DESERT COVE AVE STE 120A
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6984
Mailing Address - Country:US
Mailing Address - Phone:480-661-5232
Mailing Address - Fax:480-661-5231
Practice Address - Street 1:8962 E DESERT COVE AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6984
Practice Address - Country:US
Practice Address - Phone:480-661-5232
Practice Address - Fax:480-661-5231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC 2894261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ629438Medicaid
AZZ67641Medicare PIN
AZ629438Medicaid