Healthcare Provider Details

I. General information

NPI: 1831545417
Provider Name (Legal Business Name): ORTHOPEDIC SURGERY ASSISTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9003 E SHEA BLVD
SCOTTSDALE AZ
85260-6709
US

IV. Provider business mailing address

20235 N CAVE CREEK RD STE. 104-239
PHOENIX AZ
85024-4424
US

V. Phone/Fax

Practice location:
  • Phone: 602-908-2025
  • Fax:
Mailing address:
  • Phone: 602-908-2025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3145
License Number StateAZ

VIII. Authorized Official

Name: MR. KEVIN P CANTWELL
Title or Position: PAC, OWNER/MANAGER
Credential: PAC
Phone: 602-908-2025