Peoria Stadium Creek ASC LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

PEORIA STADIUM CREEK ASC LLC

Practice address

15000 N 83Rd Ave, Suite 105
Peoria, AZ 85381-2001

Phone

(623) 266-1919

Fax

(623) 321-9948

NPI assigned

Jun 8, 2026

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jay McKim

Title

Evp Chief Financial Officer

Phone

(949) 680-3443

Specialties & licenses 1

Addresses

Other names 1

• Peoria Stadium Creek Surgery Ctr Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1780876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780876800000",
    "number": "1134053085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15000 N 83RD AVE, SUITE 105",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853812001",
            "telephone_number": "623-266-1919",
            "fax_number": "623-321-9948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15000 N 83RD AVE, SUITE 105",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853812001",
            "telephone_number": "623-266-1919",
            "fax_number": "623-321-9948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEORIA STADIUM CREEK ASC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-06-08",
        "last_updated": "2026-06-08",
        "certification_date": "2026-06-08",
        "status": "A",
        "authorized_official_last_name": "MCKIM",
        "authorized_official_first_name": "JAY",
        "authorized_official_title_or_position": "EVP CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "949-680-3443"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peoria Stadium Creek Surgery Ctr",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Peoria Pain Physicians
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• Peoria Urgent Care Center,LLC
• Peoria Vista Care LLC
• Peoria Wound Care, LLC

• Ambulatory Surgical Clinic/Center in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Ambulatory Surgical Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.