Organization
ORTHOPEDIC SPECIALISTS OF NORTH AMERICA PLLC
Active
Parent organization
ORTHOPEDIC SPECIALISTS OF NORTH AMERICA, PLLC
Other names
OthoArizona
Organization subpart
Yes
Provider details
NPI number
Legal business name
ORTHOPEDIC SPECIALISTS OF NORTH AMERICA, PLLC
Authorized official
MS. DAWN M WELLS (CREDENTIALING SUPERVISOR)
(602) 385-2115
Entity
Organization
Contact information
Practice address
4222 E THOMAS RD, SUITE 250, PHOENIX, AZ 85018-7607
(602) 772-3800
(602) 772-3801
Mailing address
PO BOX 271429, SALT LAKE CITY, UT 84127-1429
(602) 772-3800
(602) 772-3801
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XS0106X
Orthopaedic Hand Surgery Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DQ4501
MEDICARE RAILROAD PTAN
AZ
Enumeration date
03/22/2017
Last updated
09/26/2019
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