Provider Demographics
NPI:1114109642
Name:ORTHOPEDICS OF NORTH SCOTTSDALE
Entity Type:Organization
Organization Name:ORTHOPEDICS OF NORTH SCOTTSDALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDEPOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-661-8348
Mailing Address - Street 1:9220 E MOUNTAIN VIEW RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5134
Mailing Address - Country:US
Mailing Address - Phone:480-661-8348
Mailing Address - Fax:480-661-6971
Practice Address - Street 1:9220 E MOUNTAIN VIEW RD STE 102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5134
Practice Address - Country:US
Practice Address - Phone:480-661-8348
Practice Address - Fax:480-661-6971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21407261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5488450001Medicare NSC