Healthcare Provider Details

I. General information

NPI: 1598706939
Provider Name (Legal Business Name): SUN VALLEY ORTHOPEDIC SURGEONS GENERAL PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12361 W BOLA DR STE 100
SURPRISE AZ
85378-9021
US

IV. Provider business mailing address

12361 W BOLA DR STE 100
SURPRISE AZ
85378
US

V. Phone/Fax

Practice location:
  • Phone: 623-584-5626
  • Fax: 623-584-8998
Mailing address:
  • Phone: 623-584-5626
  • Fax: 623-584-8998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number11425
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number4221
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number34748
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number13525
License Number StateAZ
# 7
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number35083
License Number StateAZ
# 8
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number665
License Number StateAZ
# 9
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0892
License Number StateAZ
# 10
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1444
License Number StateAZ
# 11
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3597
License Number StateAZ
# 12
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3122
License Number StateAZ
# 13
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0604150
License Number StateAZ

VIII. Authorized Official

Name: DR. MARTIN G STERUSKY
Title or Position: PARTNER
Credential: MD
Phone: 623-584-5626