Healthcare Provider Details

I. General information

NPI: 1609420702
Provider Name (Legal Business Name): ORTHOPEDIC SPECIALISTS OF NORTH AMERICA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10250 N 92ND ST STE 308
SCOTTSDALE AZ
85258-4520
US

IV. Provider business mailing address

PO BOX 271429
SALT LAKE CITY UT
84127-1429
US

V. Phone/Fax

Practice location:
  • Phone: 602-631-3166
  • Fax: 602-631-3162
Mailing address:
  • Phone: 602-631-3166
  • Fax:

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 Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DAWN WELLS
Title or Position: CREDENTIALING SUPERVISOR
Credential:
Phone: 602-385-2115