Provider Demographics
NPI:1144465410
Name:DOCTORS OUTPATIENT SURGICAL CENTER
Entity type:Organization
Organization Name:DOCTORS OUTPATIENT SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:EUBANK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-839-2020
Mailing Address - Street 1:2155 E CONFERENCE DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284
Mailing Address - Country:US
Mailing Address - Phone:480-839-2020
Mailing Address - Fax:480-839-2121
Practice Address - Street 1:2155 E CONFERENCE DR
Practice Address - Street 2:SUITE 111
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-2604
Practice Address - Country:US
Practice Address - Phone:480-839-2020
Practice Address - Fax:480-839-2121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-15
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC4604261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ03-C0001321OtherCMS CERTIFICATION