Peoria Stadium Creek Asc LLC
Clinic/Center, Ambulatory Surgical in Peoria, AZ. Organization (NPI-2).
Details
- NPI
- 1134053085
- Entity type
- Organization (NPI-2)
- Legal business name
- Peoria Stadium Creek Asc LLC
- Organization subpart
- No
- Enumeration date
- Jun 8, 2026
- Certification date
- Jun 8, 2026
- Last updated
- Jun 8, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QA1903X | Clinic/Center, Ambulatory Surgical | – | – | Yes |
Other names
- Peoria Stadium Creek Surgery Ctr (Doing Business As)
Practice location
15000 N 83rd Ave, Suite 105Peoria, AZ 85381-2001
Phone 623-266-1919 · Fax 623-321-9948
Mailing address
15000 N 83rd Ave, Suite 105Peoria, AZ 85381-2001
Phone 623-266-1919 · Fax 623-321-9948
Authorized official
Jay McKim
Evp Chief Financial Officer
9496803443
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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