Provider Demographics
NPI:1104178797
Name:ORTHOPEDIC SPECIALISTS OF NORTH AMERICA, PLLC
Entity Type:Organization
Organization Name:ORTHOPEDIC SPECIALISTS OF NORTH AMERICA, PLLC
Other - Org Name:OSNA - MVP DIVISION
Other - Org Type:Other Name
Authorized Official - Title/Position:PAYOR RELATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-772-3800
Mailing Address - Street 1:PO BOX 29870
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9870
Mailing Address - Country:US
Mailing Address - Phone:602-772-3800
Mailing Address - Fax:602-772-3801
Practice Address - Street 1:4344 W BELL RD
Practice Address - Street 2:STE 102
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3589
Practice Address - Country:US
Practice Address - Phone:602-588-4040
Practice Address - Fax:602-588-4034
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPEDIC SPECIALISTS OF NORTH AMERICA, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-08
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDQ4501OtherRAILROAD MEDICARE PTAN
AZZ136714Medicare PIN