1558720300 NPI number — ORTHOPEDIC SPECIALISTS OF NORTH AMERICA PLLC

Table of content: (NPI 1558720300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558720300 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:
Provider Other Organization Name Type Code:
6
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:
1558720300
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 80217
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:
85060-0217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-385-2115
Provider Business Mailing Address Fax Number:
480-418-3323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6116 E ARBOR AVE
Provider Second Line Business Practice Location Address:
STE 118
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85206-6107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-924-1552
Provider Business Practice Location Address Fax Number:
480-830-8417
Provider Enumeration Date:
02/22/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MANAGER
Authorized Official First Name:
CREDENTIALING
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
602-385-2115

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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".
  • Identifier: 6419820018 . This is a "NSC" identifier . This identifiers is of the category "OTHER".




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