Organization
DOCTORS SURGERY CENTER OF KINGMAN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MYRON E MACHULA (EXECUTIVE ADMINISTRATOR)
(928) 681-4214
Entity
Organization
Contact information
Practice address
1740 SYCAMORE AVE, KINGMAN, AZ 86409-0927
(928) 681-4214
(928) 681-4226
Mailing address
1740 SYCAMORE AVENUE, KINGMAN, AZ 86409
(928) 681-4214
(928) 681-4226
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
OSC 2913
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
629420
—
AZ
01
—
AZ0207340
BCBSAZ
AZ
Enumeration date
04/07/2006
Last updated
08/22/2020
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