Provider Demographics
NPI:1164507190
Name:CANYON ORTHOPAEDIC SURGEONS, A DIVISION OF OSNA, PLLC
Entity Type:Organization
Organization Name:CANYON ORTHOPAEDIC SURGEONS, A DIVISION OF OSNA, PLLC
Other - Org Name:CANYON ORTHOPAEDIC SURGEONS
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:POINDEXTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-846-7614
Mailing Address - Street 1:10450 W MCDOWELL RD
Mailing Address - Street 2:STE 102
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-4802
Mailing Address - Country:US
Mailing Address - Phone:623-846-7614
Mailing Address - Fax:623-846-0993
Practice Address - Street 1:6760 W THUNDERBIRD RD
Practice Address - Street 2:STE E110
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5048
Practice Address - Country:US
Practice Address - Phone:623-846-7614
Practice Address - Fax:623-846-0993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0692950006Medicare NSC
WCHKHMedicare PIN