# HAVASU SURGERY CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Havasu Surgery Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386619484
- **Authorized official:** WILLIAM M. GRACEY (COO)
- **Authorized official phone:** (615) 372-8500

## Contact information

- **Practice address:** 1775 MCCULLOCH BLVD, LAKE HAVASU CITY, AZ 86403
- **Practice address phone:** (928) 453-4200
- **Practice address fax:** (928) 453-8271
- **Mailing address:** 103 POWELL CT, STE. 200, BRENTWOOD, TN 37027-5079
- **Mailing address phone:** (615) 372-8500
- **Mailing address fax:** (615) 372-8572

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | OSC2912 | AZ | Yes |

## Other

- **Enumeration date:** 02/22/2006
- **Last updated:** 08/22/2020