Provider Demographics
NPI: | 1598706939 |
---|---|
Name: | SUN VALLEY ORTHOPEDIC SURGEONS GENERAL PARTNERSHIP |
Entity Type: | Organization |
Organization Name: | SUN VALLEY ORTHOPEDIC SURGEONS GENERAL PARTNERSHIP |
Other - Org Name: | SUNVALLEY ORTHOPAEDIC & HAND SURGEONS |
Other - Org Type: | Former Legal Business Name |
Authorized Official - Title/Position: | PARTNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | MARTIN |
Authorized Official - Middle Name: | G |
Authorized Official - Last Name: | STERUSKY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 623-584-5626 |
Mailing Address - Street 1: | 12361 W BOLA DR |
Mailing Address - Street 2: | STE 100 |
Mailing Address - City: | SURPRISE |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85378 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 623-584-5626 |
Mailing Address - Fax: | 623-584-8998 |
Practice Address - Street 1: | 12361 W BOLA DR |
Practice Address - Street 2: | STE 100 |
Practice Address - City: | SURPRISE |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85378-9021 |
Practice Address - Country: | US |
Practice Address - Phone: | 623-584-5626 |
Practice Address - Fax: | 623-584-8998 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-06-09 |
Last Update Date: | 2013-06-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AZ | 207X00000X | |
AZ | 11425 | 207XS0106X |
207XS0114X | ||
AZ | 4221 | 207XS0114X |
AZ | 34748 | 207XS0114X |
AZ | 13525 | 207XS0117X |
AZ | 35083 | 207XX0005X |
AZ | 665 | 213ES0103X |
AZ | 0892 | 225100000X |
AZ | 1444 | 225100000X |
AZ | 3597 | 363A00000X |
AZ | 3122 | 363A00000X |
AZ | F0604150 | 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207XS0106X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | Group - Multi-Specialty |
No | 207XS0114X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | Group - Multi-Specialty |
No | 207XS0117X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | Group - Multi-Specialty |
No | 207XX0005X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | Group - Multi-Specialty |
No | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | Group - Multi-Specialty |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AZ | CN1748 | Other | RAILROAD MEDICARE |
AZ | P0298960 | Other | BC/BS PHYSICAL THERAPY |
AZ | CN1748 | Other | RAILROAD MEDICARE |
AZ | 0321470001 | Medicare NSC |