Organization
REGENCY AMBULATORY SURGERY CENTER ONE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON MUSSMAN (OWNER)
(623) 243-9077
Entity
Organization
Contact information
Practice address
14725 W MOUNTAIN VIEW BLVD, SURPRISE, AZ 85374-2704
(623) 243-9077
Mailing address
14753 W MOUNTAIN VIEW BLVD, SURPRISE, AZ 85374
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
843154819
IRS
—
Enumeration date
02/20/2020
Last updated
09/21/2022
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