Healthcare Provider Details

I. General information

NPI: 1811233554
Provider Name (Legal Business Name): OSNA PRIMARY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2012
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8630 E VIA DE VENTURA SUITE 201
SCOTTSDALE AZ
85258-3326
US

IV. Provider business mailing address

PO BOX 271429 SUITE 325
SALT LAKE CITY UT
84127-1429
US

V. Phone/Fax

Practice location:
  • Phone: 480-558-3744
  • Fax:
Mailing address:
  • Phone: 602-772-3800
  • Fax: 602-772-3801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DOUG VANG
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 602-772-3800