Provider Demographics
NPI:1326223785
Name:SCOTTSDALE ORTHOPEDIC SPECIALISTS,LTD
Entity Type:Organization
Organization Name:SCOTTSDALE ORTHOPEDIC SPECIALISTS,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-946-9099
Mailing Address - Street 1:7331 E OSBORN DR STE 230
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6415
Mailing Address - Country:US
Mailing Address - Phone:480-946-9099
Mailing Address - Fax:480-946-4038
Practice Address - Street 1:7331 E OSBORN DR STE 230
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6415
Practice Address - Country:US
Practice Address - Phone:480-946-9099
Practice Address - Fax:480-946-4038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15483174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0183630OtherBC/BS
AZ4206500OtherCIGNA
AZ284464Medicaid
AZZ60084Medicare PIN
AZ4206500OtherCIGNA
D44120Medicare UPIN
0384420001Medicare NSC