Provider Demographics
NPI:1659970242
Name:ORTHOPEDIC SPECIALISTS OF NORTH AMERICA PLLC
Entity Type:Organization
Organization Name:ORTHOPEDIC SPECIALISTS OF NORTH AMERICA PLLC
Other - Org Name:ORTHOARIZONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DALEINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BULGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-385-2115
Mailing Address - Street 1:PO BOX 80217
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85060-0217
Mailing Address - Country:US
Mailing Address - Phone:602-385-2115
Mailing Address - Fax:
Practice Address - Street 1:33300 N 32ND AVE # 320
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-8877
Practice Address - Country:US
Practice Address - Phone:602-385-2115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPEDIC SPECIALISTS OF NORTH AMERICA PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-23
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty