Provider Demographics
NPI:1073569182
Name:EAST VALLEY ORTHOPEDIC AND SPINE ASSOC
Entity Type:Organization
Organization Name:EAST VALLEY ORTHOPEDIC AND SPINE ASSOC
Other - Org Name:DR JOHN YORK DO LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGAER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-449-2401
Mailing Address - Street 1:1492 S MILL AVE
Mailing Address - Street 2:1492 S MILL AVE #212
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-5664
Mailing Address - Country:US
Mailing Address - Phone:480-449-3867
Mailing Address - Fax:480-449-3868
Practice Address - Street 1:1492 S MILL AVE
Practice Address - Street 2:1492 S MILL AVE #212
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5652
Practice Address - Country:US
Practice Address - Phone:480-449-3867
Practice Address - Fax:480-449-3868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3893207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ776974Medicaid
AZH08853Medicare UPIN
AZZ75005Medicare ID - Type Unspecified