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General NPI Number Information
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NPI Number | 1588966170
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Entity Type | Organization
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Legal Business Name | THE CENTER FOR ORTHOPEDIC RESEARCH AND EDUCATION, INC.
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Dates
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Enumeration Date | 12/02/2010
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Last Update Date | 12/02/2010
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Provider Practice Location Address
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Address Line | 1001 DIVISION ST
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City | PRESCOTT
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State | AZ
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Zip | 86301-1618
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Country | US
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Telephone | 928-776-0137
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Fax |
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Provider Business Mailing Address
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Address Line | 3010 W AGUA FRIA FWY SUITE 100
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City | PHOENIX
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State | AZ
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Zip | 85027-3943
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Country | US
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Telephone | 623-537-5600
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Fax | 866-939-2673
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID J. JACOFSKY
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Credential | M.D
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Telephone | 623-537-5600
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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 | 33149
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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