Healthcare Provider Details

I. General information

NPI: 1407179518
Provider Name (Legal Business Name): ORTHOPEDIC SPECIALISTS OF NORTH AMERICA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20325 N 51ST AVE SUITE 124
GLENDALE AZ
85308-5674
US

IV. Provider business mailing address

PO BOX 271429
SALT LAKE CITY UT
84127-1429
US

V. Phone/Fax

Practice location:
  • Phone: 602-795-6300
  • Fax: 623-414-3311
Mailing address:
  • Phone: 602-772-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN KINNA
Title or Position: CEO
Credential:
Phone: 602-772-3790