Healthcare Provider Details

I. General information

NPI: 1174014864
Provider Name (Legal Business Name): PHOENIX ORTHOPAEDIC CONSULTANTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18699 N 67TH AVE STE 120
GLENDALE AZ
85308-7141
US

IV. Provider business mailing address

19636 N 27TH AVE STE 401
PHOENIX AZ
85027-4021
US

V. Phone/Fax

Practice location:
  • Phone: 602-298-8888
  • Fax:
Mailing address:
  • Phone: 602-424-1886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MARCIA HALL
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 602-424-1886