Healthcare Provider Details

I. General information

NPI: 1114143567
Provider Name (Legal Business Name): ARIZONA PROSTHETIC ORTHOTICS SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2933 N CAMPBELL AVE
TUCSON AZ
85719-2801
US

IV. Provider business mailing address

15855 N GREENWAY HAYDEN LOOP STE 140
SCOTTSDALE AZ
85260-1660
US

V. Phone/Fax

Practice location:
  • Phone: 520-229-0622
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number07-668261-R
License Number StateAZ

VIII. Authorized Official

Name: MR. ROGER GOETTL
Title or Position: COO
Credential:
Phone: 520-229-0622