Healthcare Provider Details

I. General information

NPI: 1174239727
Provider Name (Legal Business Name): TOTAL ORTHOPEDICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22601 N 19TH AVE STE 112
PHOENIX AZ
85027-1324
US

IV. Provider business mailing address

22601 N 19TH AVE STE 112
PHOENIX AZ
85027-1324
US

V. Phone/Fax

Practice location:
  • Phone: 602-293-3277
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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