Organization
EXCEPTIONAL SURGICAL PROVIDERS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VANESSA KOZIOL (CREDENTIALING SPECIALIST)
(602) 395-0718
Entity
Organization
Contact information
Practice address
7600 N 15TH ST STE 290, PHOENIX, AZ 85020-4336
(602) 395-0718
(602) 277-8146
Mailing address
8989 N GAINEY CENTER DR UNIT 145, SCOTTSDALE, AZ 85258-2114
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PEND
—
AZ
Enumeration date
06/09/2021
Last updated
07/07/2021
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