Provider Demographics
NPI:1376513291
Name:INSTITUTE FOR BONE AND JOINT DISORDERS PC
Entity Type:Organization
Organization Name:INSTITUTE FOR BONE AND JOINT DISORDERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-553-3113
Mailing Address - Street 1:1928 E HIGHLAND AVE
Mailing Address - Street 2:STE F104 PMB 443
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4626
Mailing Address - Country:US
Mailing Address - Phone:602-553-3113
Mailing Address - Fax:602-667-7991
Practice Address - Street 1:2122 E HIGHLAND AVE
Practice Address - Street 2:STE 300
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4739
Practice Address - Country:US
Practice Address - Phone:602-553-3113
Practice Address - Fax:602-667-7991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0848050003OtherPTAN
AZZWCHWMMedicare PIN