Provider Demographics
NPI:1558720300
Name:ORTHOPEDIC SPECIALISTS OF NORTH AMERICA PLLC
Entity Type:Organization
Organization Name:ORTHOPEDIC SPECIALISTS OF NORTH AMERICA PLLC
Other - Org Name:ORTHOPEDIC SPECIALISTS OF NORTH AMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING AUTHORITY
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGLERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-385-2115
Mailing Address - Street 1:PO BOX 271429
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-1429
Mailing Address - Country:US
Mailing Address - Phone:602-772-3800
Mailing Address - Fax:602-772-3801
Practice Address - Street 1:6116 E ARBOR AVE
Practice Address - Street 2:STE 118
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-6107
Practice Address - Country:US
Practice Address - Phone:480-924-1552
Practice Address - Fax:480-830-8417
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPEDIC SPECIALISTS OF NORTH AMERICA PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-22
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6419820018OtherNSC
AZDQ4501OtherRAILROAD MEDICARE PTAN