Organization
CANYON AMBULATORY SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER BOYD BALDOCK (OFFICER AND AUTHORIZED OFFICIALS)
(615) 234-5954
Entity
Organization
Contact information
Practice address
6036 N 19TH AVE, SUITE 100, PHOENIX, AZ 85015-2106
(602) 589-8000
(602) 249-8084
Mailing address
6036 N 19TH AVE, SUITE 100, PHOENIX, AZ 85015-2106
(602) 589-8000
(602) 249-8084
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
OSC2285
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
479437
—
AZ
Enumeration date
10/17/2006
Last updated
02/12/2023
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