Healthcare Provider Details

I. General information

NPI: 1356940274
Provider Name (Legal Business Name): ARIZONA CENTERS FOR ORTHOBIOLOGICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 E BASELINE RD STE 103
TEMPE AZ
85283-1204
US

IV. Provider business mailing address

610 E BASELINE RD STE 103
TEMPE AZ
85283-1204
US

V. Phone/Fax

Practice location:
  • Phone: 480-778-1400
  • Fax: 602-297-6997
Mailing address:
  • Phone: 480-778-1400
  • Fax: 602-297-6997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TINA MANKIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 602-510-3203