Provider Demographics
NPI:1265803605
Name:ARIZONA INSTITUTE FOR SPORTS KNEES AND SHOULDERS, LLC
Entity type:Organization
Organization Name:ARIZONA INSTITUTE FOR SPORTS KNEES AND SHOULDERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAILIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-264-6995
Mailing Address - Street 1:9375 E SHEA BLVD
Mailing Address - Street 2:SUITE 263
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6991
Mailing Address - Country:US
Mailing Address - Phone:480-264-6995
Mailing Address - Fax:844-574-8199
Practice Address - Street 1:20401 N 73RD ST
Practice Address - Street 2:160
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4107
Practice Address - Country:US
Practice Address - Phone:480-264-6995
Practice Address - Fax:844-574-8166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty