1871723866 NPI number — AZ ORTHO PA PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871723866 NPI number — AZ ORTHO PA PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AZ ORTHO PA 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:
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:
1871723866
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7119 E SHEA BLVD
Provider Second Line Business Mailing Address:
SUITE 109-233
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85254-6107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-510-2818
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20201 N SCOTTSDALE HEALTHCARE DR
Provider Second Line Business Practice Location Address:
SUITE 280
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85255-4134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-473-3668
Provider Business Practice Location Address Fax Number:
480-473-3671
Provider Enumeration Date:
07/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SPICER
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
480-510-2818

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  3580 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 167289 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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