Healthcare Provider Details

I. General information

NPI: 1336215409
Provider Name (Legal Business Name): FIKES ORTHOPEDIC SPECIALTIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 WHITE SPAR RD
PRESCOTT AZ
86303-4631
US

IV. Provider business mailing address

6343 E MAIN ST STE B1
MESA AZ
85205-8972
US

V. Phone/Fax

Practice location:
  • Phone: 928-227-2621
  • Fax: 928-227-3084
Mailing address:
  • Phone: 480-981-7393
  • Fax: 480-981-5807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. CONNIE S. FIKES
Title or Position: TREASURER
Credential: RN
Phone: 480-981-7393