Healthcare Provider Details

I. General information

NPI: 1003423609
Provider Name (Legal Business Name): ARIZONA CENTERS FOR ORTHOBIOLOGICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9475 E IRONWOOD SQUARE DR STE 100
SCOTTSDALE AZ
85258-4576
US

IV. Provider business mailing address

9475 E IRONWOOD SQUARE DR STE 100
SCOTTSDALE AZ
85258-4576
US

V. Phone/Fax

Practice location:
  • Phone: 480-778-1400
  • Fax:
Mailing address:
  • Phone: 480-778-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TINA MANKIN
Title or Position: ADMINISTRATOR/DIRECTOR OF NURSING
Credential:
Phone: 602-510-3203