Provider Demographics
NPI:1366837809
Name:CENTER FOR ORTHOPEDIC RESEARCH AND EDUCATION
Entity Type:Organization
Organization Name:CENTER FOR ORTHOPEDIC RESEARCH AND EDUCATION
Other - Org Name:THE CORE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO & CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:JACOFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-974-2673
Mailing Address - Street 1:18444 N 25TH AVE
Mailing Address - Street 2:STE 310
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-1266
Mailing Address - Country:US
Mailing Address - Phone:866-974-2673
Mailing Address - Fax:866-939-2673
Practice Address - Street 1:4485 S I-19 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85416
Practice Address - Country:US
Practice Address - Phone:866-974-2673
Practice Address - Fax:866-939-2673
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR ORTHOPEDIC RESEARCH AND EDUCATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ332B00000X, 332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0000000000Medicare NSC