Provider Demographics
NPI:1063855088
Name:OSNA PRIMARY CARE, LLC
Entity Type:Organization
Organization Name:OSNA PRIMARY CARE, LLC
Other - Org Name:MEZONA ORTHOPAEDIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KINNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-772-3800
Mailing Address - Street 1:PO BOX 271429
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-1429
Mailing Address - Country:US
Mailing Address - Phone:602-772-3800
Mailing Address - Fax:602-772-3801
Practice Address - Street 1:2940 E BANNER GATEWAY DR
Practice Address - Street 2:STE 200
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2171
Practice Address - Country:US
Practice Address - Phone:480-964-2908
Practice Address - Fax:480-833-2136
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OSNA PRIMARY CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-09
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ156957Medicare PIN