Provider Demographics
NPI:1467950527
Name:ORTHOPEDIC SURGERY CENTER OF SCOTTSDALE, LLC
Entity Type:Organization
Organization Name:ORTHOPEDIC SURGERY CENTER OF SCOTTSDALE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-510-3203
Mailing Address - Street 1:21001 N TATUM BLVD STE 1630-466
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4242
Mailing Address - Country:US
Mailing Address - Phone:602-510-3203
Mailing Address - Fax:602-297-6997
Practice Address - Street 1:2629 N SCOTTSDALE RD STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-1370
Practice Address - Country:US
Practice Address - Phone:602-510-3203
Practice Address - Fax:602-297-6997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical