Healthcare Provider Details

I. General information

NPI: 1629906094
Provider Name (Legal Business Name): ORTHOAZ SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 E MELROSE ST
GILBERT AZ
85297-1001
US

IV. Provider business mailing address

1675 E MELROSE ST
GILBERT AZ
85297-1001
US

V. Phone/Fax

Practice location:
  • Phone: 480-519-8100
  • Fax:
Mailing address:
  • Phone: 480-519-8101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEXAS GAGE
Title or Position: INSURANCE VERIFIER
Credential:
Phone: 480-519-8100