Healthcare Provider Details

I. General information

NPI: 1114109642
Provider Name (Legal Business Name): ORTHOPEDICS OF NORTH SCOTTSDALE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9220 E MOUNTAIN VIEW RD STE 102
SCOTTSDALE AZ
85258-5134
US

IV. Provider business mailing address

9220 E MOUNTAIN VIEW RD STE 102
SCOTTSDALE AZ
85258-5134
US

V. Phone/Fax

Practice location:
  • Phone: 480-661-8348
  • Fax: 480-661-6971
Mailing address:
  • Phone: 480-661-8348
  • Fax: 480-661-6971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number21407
License Number StateAZ

VIII. Authorized Official

Name: LINDSEY VANDEPOL
Title or Position: OFFICE MANAGER
Credential:
Phone: 480-661-8348