# PEORIA STADIUM CREEK ASC LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Peoria Stadium Creek Surgery Ctr
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134053085
- **Authorized official:** JAY MCKIM (EVP CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (949) 680-3443

## Contact information

- **Practice address:** 15000 N 83RD AVE, SUITE 105, PEORIA, AZ 85381-2001
- **Practice address phone:** (623) 266-1919
- **Practice address fax:** (623) 321-9948
- **Mailing address:** 15000 N 83RD AVE, SUITE 105, PEORIA, AZ 85381-2001
- **Mailing address phone:** (623) 266-1919
- **Mailing address fax:** (623) 321-9948

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/08/2026
- **Last updated:** 06/08/2026