Organization
BANNER ENTICARE TEMPE SURGERY CENTER LLC
Active
Other names
Banner Tempe Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HOMAN MOSTAFAVI DO (MANAGER-MEMBER)
(248) 229-6188
Entity
Organization
Contact information
Practice address
1940 E SOUTHERN AVE, TEMPE, AZ 85282-7518
(480) 820-7101
Mailing address
2355 E CAMELBACK RD STE 700, PHOENIX, AZ 85016-9044
(602) 550-0428
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
02/20/2019
Last updated
02/11/2020
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