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General NPI Number Information
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NPI Number | 1912637786
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Entity Type | Organization
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Legal Business Name | SOUTHWEST INSTITUTE OF ADVANCING HIP AND KNEE TECHNOLOGIES, PLLC
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Dates
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Enumeration Date | 06/14/2022
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Last Update Date | 09/07/2025
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Provider Practice Location Address
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Address Line | 95 SOLDIERS PASS RD STE B1
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City | SEDONA
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State | AZ
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Zip | 86336-4712
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Country | US
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Telephone | 928-600-0479
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Fax |
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Provider Business Mailing Address
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Address Line | 10910 BROWN BEAR RD
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City | FLAGSTAFF
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State | AZ
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Zip | 86004-1577
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Country | US
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Telephone | 928-600-0479
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Fax |
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Authorized Official
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Title or Position | MD OWNER
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Name | AMBER RANDALL
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Credential |
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Telephone | 928-600-0479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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