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General NPI Number Information
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NPI Number | 1225190820
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Entity Type | Organization
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Legal Business Name | ARIZONA COLLEGE OF ORTHOPEDIC SURGEONS, PLLC
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 01/19/2010
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Provider Practice Location Address
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Address Line | 10815 W MCDOWELL RD SUITE 303
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City | AVONDALE
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State | AZ
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Zip | 85392-5007
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Country | US
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Telephone | 602-424-0935
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Fax | 602-938-4241
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Provider Business Mailing Address
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Address Line | PO BOX 10610
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City | GLENDALE
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State | AZ
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Zip | 85318-0610
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Country | US
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Telephone | 602-424-0935
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Fax | 602-938-4241
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Authorized Official
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Title or Position | PRESIDENT
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Name | KIT C MCCALLA
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Credential | DO, MBA
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Telephone | 602-424-0935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 3671
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License Number State | AZ
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