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Organization
SURPRISE MEDICAL LLC
Active
Organization
SURPRISE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHALLEN WAYCHOFF III (COO/MANAGER)
(480) 634-6400
Entity
Organization
Contact information
Practice address
16960 W BELL RD STE 501, SURPRISE, AZ 85374-8946
(480) 634-6400
(480) 404-9649
Mailing address
3724 N 3RD ST STE 301, PHOENIX, AZ 85012-2035
(480) 634-6400
(480) 404-9649
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
NULL
171M00000X
Case Manager/Care Coordinator
—
—
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Enumeration date
01/31/2018
Last updated
03/12/2018
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