Provider Demographics
NPI:1801028048
Name:WESTERN SURGICAL SERVICES, PLLC
Entity type:Organization
Organization Name:WESTERN SURGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:CODDINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:CFA
Authorized Official - Phone:602-708-2493
Mailing Address - Street 1:PO BOX 12144
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85267-2144
Mailing Address - Country:US
Mailing Address - Phone:602-708-2493
Mailing Address - Fax:480-699-6264
Practice Address - Street 1:7672 E DAVENPORT DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-4020
Practice Address - Country:US
Practice Address - Phone:602-708-2493
Practice Address - Fax:480-699-6264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1597297246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty