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General NPI Number Information
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NPI Number | 1841561859
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Entity Type | Organization
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Legal Business Name | KENNEDY ORTHOPEDIC SERVICES, INC.
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Dates
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Enumeration Date | 01/23/2012
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Last Update Date | 06/28/2012
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Provider Practice Location Address
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Address Line | 1819 E YALE DR
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City | TEMPE
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State | AZ
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Zip | 85283-2249
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Country | US
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Telephone | 602-320-0335
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Fax | 480-248-8993
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Provider Business Mailing Address
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Address Line | 1819 E YALE DR
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City | TEMPE
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State | AZ
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Zip | 85283-2249
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Country | US
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Telephone | 602-320-0335
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Fax | 480-248-8993
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RYAN DAVID KENNEDY
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Credential |
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Telephone | 602-320-0335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 2765
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License Number State | AZ
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