# BANNER ARIZONA ASC LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Jon R. Hillegas Surgery Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790759355
- **Authorized official:** MR. PHILLIP A CLENDENIN (PRESIDENT)
- **Authorized official phone:** (615) 665-1283

## Contact information

- **Practice address:** 13640 N PLAZA DEL RIO BLVD, SUITE 135, PEORIA, AZ 85381-4846
- **Practice address phone:** (623) 876-3943
- **Practice address fax:** (623) 876-6946
- **Mailing address:** 13640 N PLAZA DEL RIO BLVD, SUITE 135, PEORIA, AZ 85381-4846
- **Mailing address phone:** (623) 876-3943
- **Mailing address fax:** (623) 876-6946

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | OSC3316 | AZ | Yes |

## Other

- **Enumeration date:** 02/13/2006
- **Last updated:** 09/07/2023