Healthcare Provider Details

I. General information

NPI: 1326302472
Provider Name (Legal Business Name): TOTAL ORTHOPEDICS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18001 N 79TH AVE SUITE D-69
GLENDALE AZ
85308-8388
US

IV. Provider business mailing address

18001 N 79TH AVE SUITE D-69
GLENDALE AZ
85308-8388
US

V. Phone/Fax

Practice location:
  • Phone: 483-443-0384
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number44D1072470
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

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