MEDICARE: FOOTHILLS ORTHOPAEDIC SPECIALISTS, PC

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	207X00000X	Orthopaedic Surgery Physician	28675	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	710419	OTHER	AZ	AHCCC

General Provider Information

NPI Number	:	1134156409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOTHILLS ORTHOPAEDIC SPECIALISTS, PC

Provider Business Mailing Address
First Line	:	3219 E CAMELBACK RD STE 401
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-2307
Country	:	US
Telephone Number	:	602-252-3829
Fax Number	:	602-252-3846

Provider Business Practice Location Address
First Line	:	3135 E LINCOLN DR STE B
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-2301
Country	:	US
Telephone Number	:	602-252-3829
Fax Number	:	602-252-3846

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GREGORY M GRANT
Credential	:	M.D.
Telephone Number	:	602-252-6829

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	01/07/2020

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