Provider Demographics
NPI:1447381488
Name:SPORTS & ORTHOPAEDIC SPECIALISTS OF ARIZONA LLC
Entity Type:Organization
Organization Name:SPORTS & ORTHOPAEDIC SPECIALISTS OF ARIZONA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:HOLLIS
Authorized Official - Last Name:WEINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-222-5601
Mailing Address - Street 1:3487 S MERCY RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-0432
Mailing Address - Country:US
Mailing Address - Phone:480-222-5601
Mailing Address - Fax:480-222-5607
Practice Address - Street 1:3487 S MERCY RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-0432
Practice Address - Country:US
Practice Address - Phone:480-222-5601
Practice Address - Fax:480-222-5607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty