Organization
AMBULATORY SURGERY CENTER OF YUMA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN A WALLACE M.D. (AUTHORIZED SIGNER)
(928) 343-2180
Entity
Organization
Contact information
Practice address
2261 S AVENUE B, YUMA, AZ 85364-6103
(928) 343-2180
(928) 373-0754
Mailing address
PO BOX 27340, PHOENIX, AZ 85061-7340
(602) 943-9200
(602) 216-3000
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
697237
—
AZ
Enumeration date
03/07/2006
Last updated
12/06/2007
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