MEDICARE: ORTHOPEDIC SPECIALISTS OF NORTH AMERICA, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0106X	Orthopaedic Hand Surgery Physician		AZ
2	207X00000X	Orthopaedic Surgery Physician		AZ

General Provider Information

NPI Number	:	1033428701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPEDIC SPECIALISTS OF NORTH AMERICA, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 271429
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-1429
Country	:	US
Telephone Number	:	602-772-3800
Fax Number	:	602-772-3801

Provider Business Practice Location Address
First Line	:	13640 N 7TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-4845
Country	:	US
Telephone Number	:	602-863-2040
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOHN KINNA
Credential	:
Telephone Number	:	602-772-3790

Provider Enumeration Date	:	09/29/2010
Last Update Date	:	02/03/2017

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