Healthcare Provider Details

I. General information

NPI: 1629439005
Provider Name (Legal Business Name): GREATER PHOENIX ORTHOPEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20401 N 73RD ST SUITE 155
SCOTTSDALE AZ
85255-4107
US

IV. Provider business mailing address

20401 N 73RD ST STE 160
SCOTTSDALE AZ
85255-4149
US

V. Phone/Fax

Practice location:
  • Phone: 800-483-0726
  • Fax: 800-483-0729
Mailing address:
  • Phone: 800-483-0726
  • Fax: 800-483-0729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number34339
License Number StateAZ

VIII. Authorized Official

Name: REGINA MARIE GILLELAND
Title or Position: MANAGER
Credential:
Phone: 623-208-7979