Organization
DESERT RIDGE OUTPATIENT SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC BOON (OFFICER / AUTHORIZED OFFICIAL)
(480) 567-0269
Entity
Organization
Contact information
Practice address
20940 N TATUM BLVD, STE 100, PHOENIX, AZ 85050
(480) 502-4000
(480) 502-4050
Mailing address
20940 N TATUM BLVD, STE 100, PHOENIX, AZ 85050-4265
(480) 502-4000
(480) 502-4050
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
OSC4133
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
240194
—
AZ
01
—
P00617703
RAILROAD MEDICARE
AZ
Enumeration date
08/04/2006
Last updated
09/19/2024
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