Organization
PRESCOTT OUTPATIENT SURGICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERIC BOON (OFFICER/AUTHORIZED OFFICIAL)
(480) 567-0269
Entity
Organization
Contact information
Practice address
815 AINSWORTH DR, PRESCOTT, AZ 86301-1631
(928) 778-9770
(928) 778-9028
Mailing address
815 AINSWORTH DR, PRESCOTT, AZ 86301-1631
(928) 778-9770
(928) 778-9028
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
OSC0035
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
061482
—
AZ
Enumeration date
08/08/2006
Last updated
09/05/2024
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