Provider Demographics
NPI:1144275025
Name:SURGICARE SHERIDAN SURGICAL SERVICES
Entity type:Organization
Organization Name:SURGICARE SHERIDAN SURGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHERIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:866-692-0362
Mailing Address - Street 1:PO BOX 51058
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-0053
Mailing Address - Country:US
Mailing Address - Phone:866-692-0362
Mailing Address - Fax:480-354-7480
Practice Address - Street 1:3035 S ELLSWORTH RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-2160
Practice Address - Country:US
Practice Address - Phone:480-354-7478
Practice Address - Fax:480-354-7480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3977305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG30476Medicare UPIN
AZZ77548Medicare ID - Type Unspecified