PRESCOTT OUTPATIENT SURGICAL CENTER NPI 1083624670

NPI Information

NPI: 1083624670
Provider Name: PRESCOTT OUTPATIENT SURGICAL CENTER
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 03D0982928

Address:
815 AINSWORTH DR
PRESCOTT, AZ
ZIP 86301
Phone: (928) 778-9770
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PRESCOTT OUTPATIENT SURGICAL CENTER is an ambulatory surgical clinic center in Prescott, AZ. PRESCOTT OUTPATIENT SURGICAL CENTER NPI is 1083624670. The provider is registered as an organization entity type.

The provider's business location address is:

815 AINSWORTH DR
PRESCOTT, AZ
ZIP 86301-631
Phone: (928) 778-9770
Fax: (928) 778-9028

The provider's authorized official is Jim Pavetto .
The authorized official title is Administrator, Ceo and has the following contact phone number (928) 778-9770.

The CLIA number assigned to this NPI record is 03D0982928 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/8/2006 and was last updated on 10/24/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical	OSC0035	ARIZONA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	061482	MEDICAID	ARIZONA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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