Organization
BROCK SURGICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN LECOMPTE (MANAGER)
(480) 213-8488
Entity
Organization
Contact information
Practice address
10255 N 32ND ST, PHOENIX, AZ 85028-3822
(480) 213-8488
Mailing address
835 W WARNER RD STE 101-462, GILBERT, AZ 85233-7297
(480) 213-8488
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
OSC-17-1451
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OSC-17-1451
STATE HEALTH DEPARTMENT LICENSE
AZ
Enumeration date
09/26/2017
Last updated
07/21/2022
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