1194164335 NPI number — ORTHOPEDIC SPECIALISTS OF NORTH AMERICA, PLLC

Table of content: (NPI 1194164335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194164335 NPI number — ORTHOPEDIC SPECIALISTS OF NORTH AMERICA, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC SPECIALISTS OF NORTH AMERICA, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OSNA - GREATER PHOENIX ORTHOPEDICS
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194164335
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 29870
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85038-9870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-772-3800
Provider Business Mailing Address Fax Number:
602-772-3801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18700 N 64TH DR
Provider Second Line Business Practice Location Address:
STE 105
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85308-7110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-483-0726
Provider Business Practice Location Address Fax Number:
800-483-0729
Provider Enumeration Date:
06/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SHARP
Authorized Official First Name:
JOLIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFAO
Authorized Official Telephone Number:
602-772-3800

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207XS0106X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1200X , with the licence number: 50782 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DQ4501 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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