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Organization
STAR SURGERY CENTER, LLC
Active
Organization
STAR SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINA MANKIN (ADMINISTRATOR)
(602) 510-3203
Entity
Organization
Contact information
Practice address
14155 N 83RD AVE STE 140, PEORIA, AZ 85381-5652
(623) 248-5842
(623) 248-5843
Mailing address
14155 N 83RD AVE STE 140, PEORIA, AZ 85381-5652
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
NULL
Other
Enumeration date
01/28/2020
Last updated
01/28/2020
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