Organization
ST. JOSEPH'S OUTPATIENT SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC BOON (OFFICER/AUTHORIZED OFFICIAL)
(480) 567-0269
Entity
Organization
Contact information
Practice address
240 W THOMAS RD, PHOENIX, AZ 85013-4407
(602) 406-3552
(602) 406-7139
Mailing address
240 W THOMAS RD, PHOENIX, AZ 85013-4407
(602) 406-3552
(602) 406-7139
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
OSC3456
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
826836
—
AZ
01
—
AZ0202840
BLUE CROSS BLUE SHIELD
AZ
01
—
IZ2500
HEALTHNET
AZ
Enumeration date
07/07/2005
Last updated
01/16/2025
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