Organization
CANYON ORTHOPAEDIC SURGEONS
Active
Organization
CANYON ORTHOPAEDIC SURGEONS
Active
Other names
CANYON ORTHOPAEDIC SURGEONS
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOANNA L POINDEXTER III (ASSISTANT PRACTICE MANAGER)
(623) 846-7614
Entity
Organization
Contact information
Practice address
10450 W MCDOWELL RD, STE 102, AVONDALE, AZ 85392
(623) 846-7614
(623) 848-4738
Mailing address
10450 W MCDOWELL RD, SUITE 102, AVONDALE, AZ 85392-4802
(623) 846-7614
(623) 846-0993
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
—
—
207XS0106X
Orthopaedic Hand Surgery Physician
Primary
—
—
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0692950001
MEDICARE DMERC (AV)
AZ
01
—
1770805590
AS OF 5/1/2010, CANYON/OSNA DIVISION NPI
AZ
01
—
1770812828
EFF 5/1/2010, OSNA GROUP NPI
AZ
01
—
1982700720
CANYON GROUP NPI PRIOR TO 5/1/2010
AZ
01
—
Z136714
EFF 5/1/2010, OSNA GROUP PTAN
AZ
Enumeration date
09/16/2006
Last updated
08/04/2011
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