# CANYON AMBULATORY SURGERY CENTER, LLC

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

## Provider details

- **NPI number:** 1689755928
- **Authorized official:** JENNIFER BOYD BALDOCK (OFFICER AND AUTHORIZED OFFICIALS)
- **Authorized official phone:** (615) 234-5954

## Contact information

- **Practice address:** 6036 N 19TH AVE, SUITE 100, PHOENIX, AZ 85015-2106
- **Practice address phone:** (602) 589-8000
- **Practice address fax:** (602) 249-8084
- **Mailing address:** 6036 N 19TH AVE, SUITE 100, PHOENIX, AZ 85015-2106
- **Mailing address phone:** (602) 589-8000
- **Mailing address fax:** (602) 249-8084

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | OSC2285 | AZ | Yes |

## Other

- **Enumeration date:** 10/17/2006
- **Last updated:** 02/12/2023