Healthcare Provider Details

I. General information

NPI: 1689396848
Provider Name (Legal Business Name): BILTMORE ORTHOPEDIC ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5080 N 40TH ST STE 103
PHOENIX AZ
85018-2158
US

IV. Provider business mailing address

5080 N 40TH ST STE 103
PHOENIX AZ
85018-2158
US

V. Phone/Fax

Practice location:
  • Phone: 602-952-8111
  • Fax: 602-952-1572
Mailing address:
  • Phone: 602-952-8111
  • Fax: 602-952-1572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JAYCEN C BROWN
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 602-952-8111