NPIMap

Organization Active NPI

Havasu Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Lake Havasu City, AZ
National Provider Identifier
1386619484
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
OSC2912 Issued in AZ
Legal business name
HAVASU SURGERY CENTER
Doing business as
Havasu Surgery Center
Practice address
1775 McCulloch Blvd
Lake Havasu City, AZ 86403
Phone
(928) 453-4200
Fax
(928) 453-8271
NPI assigned
Feb 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
William M. Gracey
Title
Coo
Phone
(615) 372-8500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X OSC2912 AZ Primary

Addresses

Primary practice location

1775 McCulloch Blvd
Lake Havasu City, AZ 86403

Mailing address

103 Powell CT
Ste. 200
Brentwood, TN 37027-5079
Phone (615) 372-8500

Other names 1

  • Havasu Surgery Center Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386619484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 POWELL CT",
            "address_2": "STE. 200",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275079",
            "telephone_number": "615-372-8500",
            "fax_number": "615-372-8572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1775 MCCULLOCH BLVD",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "86403",
            "telephone_number": "928-453-4200",
            "fax_number": "928-453-8271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVASU SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GRACEY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "615-372-8500"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "AZ",
            "license": "OSC2912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Havasu Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Havasu City, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.