Provider Demographics
NPI:1871513705
Name:SQUAW PEAK SURGICAL FACILITY INC
Entity type:Organization
Organization Name:SQUAW PEAK SURGICAL FACILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:T
Authorized Official - Last Name:YEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-944-5656
Mailing Address - Street 1:1635 E MYRTLE #100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-0000
Mailing Address - Country:US
Mailing Address - Phone:602-944-5656
Mailing Address - Fax:602-944-2727
Practice Address - Street 1:1635 E MYRTLE #100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-0000
Practice Address - Country:US
Practice Address - Phone:602-944-5656
Practice Address - Fax:602-944-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOSC1965261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ22021Medicare PIN