# DOCTORS SURGERY CENTER OF KINGMAN, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407819857
- **Authorized official:** MR. MYRON E MACHULA (EXECUTIVE ADMINISTRATOR)
- **Authorized official phone:** (928) 681-4214

## Contact information

- **Practice address:** 1740 SYCAMORE AVE, KINGMAN, AZ 86409-0927
- **Practice address phone:** (928) 681-4214
- **Practice address fax:** (928) 681-4226
- **Mailing address:** 1740 SYCAMORE AVENUE, KINGMAN, AZ 86409
- **Mailing address phone:** (928) 681-4214
- **Mailing address fax:** (928) 681-4226

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | OSC 2913 | AZ | Yes |

## Other

- **Enumeration date:** 04/07/2006
- **Last updated:** 08/22/2020