1336215409 NPI number — FIKES ORTHOPEDIC SPECIALTIES, INC.

Table of content: (NPI 1336215409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336215409 NPI number — FIKES ORTHOPEDIC SPECIALTIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIKES ORTHOPEDIC SPECIALTIES, INC.
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:
Provider Other Organization Name Type Code:
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:
1336215409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6343 E MAIN ST STE B1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85205-8972
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-981-7393
Provider Business Mailing Address Fax Number:
480-981-5807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
715 WHITE SPAR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRESCOTT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86303-4631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-227-2621
Provider Business Practice Location Address Fax Number:
928-227-3084
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FIKES
Authorized Official First Name:
CONNIE
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
480-981-7393

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 197436500 . This is a "AZ US DEPT OF LABOR" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 511685 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 153543 . This is a "RURAL ARIZONA NETWORK" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0277820 . This is a "BLUE CROSS BLUE SHIELD AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1Z7008 . This is a "HEALTH NET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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