Healthcare Provider Details

I. General information

NPI: 1689823726
Provider Name (Legal Business Name): TOTAL ORTHOPEDICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2008
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 E BASELINE RD STE 113
GILBERT AZ
85234-2740
US

IV. Provider business mailing address

3303 E BASELINE RD BUILDING 6 SUITE 113
GILBERT AZ
85234-2738
US

V. Phone/Fax

Practice location:
  • Phone: 480-218-7105
  • Fax: 480-218-7108
Mailing address:
  • Phone: 480-218-7105
  • Fax: 480-218-7108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number1031582
License Number StateAZ

VIII. Authorized Official

Name: AMANDA WILKINSON
Title or Position: BUSINESS OPERATIONS DIRECTOR
Credential:
Phone: 702-818-0446