Provider Demographics
NPI:1760662266
Name:PIMA ORTHOPEDIC PHYSICIANS LLC
Entity Type:Organization
Organization Name:PIMA ORTHOPEDIC PHYSICIANS LLC
Other - Org Name:PIMA ORTHOPAEDIC ASSOCIATES PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MEDLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-624-0888
Mailing Address - Street 1:1707 W SAINT MARYS RD STE 205
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2615
Mailing Address - Country:US
Mailing Address - Phone:520-624-0888
Mailing Address - Fax:520-624-0091
Practice Address - Street 1:1707 W SAINT MARYS RD STE 205
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2615
Practice Address - Country:US
Practice Address - Phone:520-624-0888
Practice Address - Fax:520-624-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12924207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty