Organization
STATE LINE SURGICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LACEY DINH (REVENUE CYCLE MANAGER OF ABS)
(520) 258-0326
Entity
Organization
Contact information
Practice address
1310 EASTSIDE CENTRE CT # 6-142, MOUNTAIN HOME, AR 72653-2705
(520) 323-8732
(520) 547-1865
Mailing address
6339 E SPEEDWAY BLVD STE 201, TUCSON, AZ 85710-1147
(520) 323-8732
(520) 547-1865
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
AR
Other
Enumeration date
04/29/2009
Last updated
12/16/2015
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