Healthcare Provider Details

I. General information

NPI: 1164507190
Provider Name (Legal Business Name): CANYON ORTHOPAEDIC SURGEONS, A DIVISION OF OSNA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6760 W THUNDERBIRD RD STE E110
PEORIA AZ
85381-5048
US

IV. Provider business mailing address

10450 W MCDOWELL RD STE 102
AVONDALE AZ
85392-4802
US

V. Phone/Fax

Practice location:
  • Phone: 623-846-7614
  • Fax: 623-846-0993
Mailing address:
  • Phone: 623-846-7614
  • Fax: 623-846-0993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOANNA L POINDEXTER
Title or Position: ASSISTANT PRACTICE MANAGER
Credential:
Phone: 623-846-7614