Healthcare Provider Details

I. General information

NPI: 1174846281
Provider Name (Legal Business Name): ORTHOPEDIC SPECIALISTS OF NORTH AMERICA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18404 N TATUM BLVD SUITE 202
PHOENIX AZ
85032-1510
US

IV. Provider business mailing address

PO BOX 29870
PHOENIX AZ
85038-9870
US

V. Phone/Fax

Practice location:
  • Phone: 480-473-3668
  • Fax: 480-473-3671
Mailing address:
  • Phone: 602-772-3800
  • Fax: 602-772-3801

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 Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL BARNES
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PH.D
Phone: 602-772-3800