Provider Demographics
NPI:1003423609
Name:ARIZONA CENTERS FOR ORTHOBIOLOGICS, LLC
Entity Type:Organization
Organization Name:ARIZONA CENTERS FOR ORTHOBIOLOGICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-510-3203
Mailing Address - Street 1:9475 E IRONWOOD SQUARE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4576
Mailing Address - Country:US
Mailing Address - Phone:480-778-1400
Mailing Address - Fax:
Practice Address - Street 1:9475 E IRONWOOD SQUARE DR STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4576
Practice Address - Country:US
Practice Address - Phone:480-778-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty