Healthcare Provider Details

I. General information

NPI: 1033387139
Provider Name (Legal Business Name): SOUTHWEST INSTITUTE OF ARTHROSCOPIC AND RECONSTRUCTIVE SURGERY, LTD.,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 S VAL VISTA DR SUITE 2
MESA AZ
85204-5667
US

IV. Provider business mailing address

1056 S VAL VISTA DR SUITE 2
MESA AZ
85204-5667
US

V. Phone/Fax

Practice location:
  • Phone: 480-834-5480
  • Fax: 480-834-3194
Mailing address:
  • Phone: 480-834-5480
  • Fax: 480-834-3194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number20383
License Number StateAZ

VIII. Authorized Official

Name: DR. JEFFREY S. LEVINE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 480-834-5480