1982700720 NPI number — CANYON ORTHOPAEDIC SURGEONS

Table of content: (NPI 1982700720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982700720 NPI number — CANYON ORTHOPAEDIC SURGEONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANYON ORTHOPAEDIC SURGEONS
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:
1982700720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10450 W MCDOWELL RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
AVONDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85392-4802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-846-7614
Provider Business Mailing Address Fax Number:
623-846-0993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10450 W MCDOWELL RD
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
AVONDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-846-7614
Provider Business Practice Location Address Fax Number:
623-848-4738
Provider Enumeration Date:
09/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
POINDEXTER
Authorized Official First Name:
JOANNA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
ASSISTANT PRACTICE MANAGER
Authorized Official Telephone Number:
623-846-7614

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0114X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0106X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Z136714 . This is a "EFF 5/1/2010, OSNA GROUP PTAN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1770805590 . This is a "AS OF 5/1/2010, CANYON/OSNA DIVISION NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1982700720 . This is a "CANYON GROUP NPI PRIOR TO 5/1/2010" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 0692950001 . This is a "MEDICARE DMERC (AV)" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1770812828 . This is a "EFF 5/1/2010, OSNA GROUP NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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