Organization
SURGICARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELLISON F HERRO MD (OWNER/MEDICAL DIRECTOR)
(602) 264-1395
Entity
Organization
Contact information
Practice address
5115 N CENTRAL AVE, PHOENIX, AZ 85012-1478
(602) 264-1818
(602) 264-2172
Mailing address
5133 N CENTRAL AVE, SUITE 200, PHOENIX, AZ 85012-1438
(602) 264-1395
(602) 264-2172
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
OSC 0051
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
062810
—
AZ
01
—
AZ0201540
BLUECROSS BLUESHIELD AZ
AZ
Enumeration date
01/27/2006
Last updated
03/20/2008
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