Healthcare Provider Details

I. General information

NPI: 1245697010
Provider Name (Legal Business Name): ALIGN MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17014 W BELL RD STE 103
SURPRISE AZ
85374-2479
US

IV. Provider business mailing address

17014 W BELL RD STE 103
SURPRISE AZ
85374-2479
US

V. Phone/Fax

Practice location:
  • Phone: 623-383-0880
  • Fax: 602-680-5161
Mailing address:
  • Phone: 623-229-6193
  • Fax: 602-680-5161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberAP8524
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JASON LEE HAWKINS
Title or Position: OWNER
Credential:
Phone: 623-383-0880