Healthcare Provider Details

I. General information

NPI: 1396890778
Provider Name (Legal Business Name): ARIZONA ORTHOPAEDIC ASSOCIATES AT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 N COFCO CENTER CT 290
PHOENIX AZ
85008-6462
US

IV. Provider business mailing address

690 N COFCO CENTER CT 290
PHOENIX AZ
85008-6462
US

V. Phone/Fax

Practice location:
  • Phone: 602-631-3161
  • Fax: 602-631-3162
Mailing address:
  • Phone: 602-631-3161
  • Fax: 602-631-3162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. TARA A DOWNES
Title or Position: BUSINESS OFFICE MANAGER
Credential: CPC CMC
Phone: 602-288-4898