59TH Avenue Surgical Facility, LTD

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

59TH AVENUE SURGICAL FACILITY, LTD

Practice address

8608 N 59TH Ave
Glendale, AZ 85302-5404

Phone

(623) 934-3211

Fax

(623) 930-1891

NPI assigned

Apr 10, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Mark Richard Gorman, D.P.M.

Title

C.E.O.

Phone

(623) 934-3211

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508089624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8608 N 59TH AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853025404",
            "telephone_number": "623-934-3211",
            "fax_number": "623-930-1891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8608 N 59TH AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853025404",
            "telephone_number": "623-934-3211",
            "fax_number": "623-930-1891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "59TH AVENUE SURGICAL FACILITY, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GORMAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "623-934-3211",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Glendale, AZ
• Providers in Glendale, 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 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.