Organization
THE ORTHOPEDIC CLINIC ASSOCIATION PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS LARAWAY (CFO)
(602) 747-4000
Entity
Organization
Contact information
Practice address
2222 E HIGHLAND AVE, SUITE 300, PHOENIX, AZ 85016-4872
(602) 277-6211
(866) 242-5309
Mailing address
2901 N CENTRAL AVE STE 160, PHOENIX, AZ 85012-2702
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
2471M1202X
Magnetic Resonance Imaging Radiologic Technologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
511031
—
AZ
01
—
WCJCV
MEDICARE ID
AZ
Enumeration date
12/18/2008
Last updated
01/13/2022
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