Provider Demographics
NPI:1801198106
Name:PHOENIX ORTHOPAEDIC SURGEONS, LTD
Entity Type:Organization
Organization Name:PHOENIX ORTHOPAEDIC SURGEONS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-773-3016
Mailing Address - Street 1:15601 N 28TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-4061
Mailing Address - Country:US
Mailing Address - Phone:602-938-5800
Mailing Address - Fax:602-863-6611
Practice Address - Street 1:15601 N 28TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-4061
Practice Address - Country:US
Practice Address - Phone:602-938-5800
Practice Address - Fax:602-863-6611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7363207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ217168Medicaid
C99547Medicare UPIN