MEDICARE: ORTHOPEDIC SPECIALISTS OF NORTH AMERICA, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207X00000X	Orthopaedic Surgery Physician
2	225100000X	Physical Therapist
3	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1811505415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPEDIC SPECIALISTS OF NORTH AMERICA, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 80217
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85060-0217
Country	:	US
Telephone Number	:	602-385-2115
Fax Number	:	480-422-6551

Provider Business Practice Location Address
First Line	:	12684 W GILA BEND HWY
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85193-9298
Country	:	US
Telephone Number	:	480-306-4174
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	DAWN MARIE WELLS
Credential	:
Telephone Number	:	602-385-2115

Provider Enumeration Date	:	07/20/2020
Last Update Date	:	07/24/2020

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