Provider Demographics
NPI:1396890778
Name:ARIZONA ORTHOPAEDIC ASSOCIATES AT
Entity type:Organization
Organization Name:ARIZONA ORTHOPAEDIC ASSOCIATES AT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOWNES
Authorized Official - Suffix:
Authorized Official - Credentials:CPC CMC
Authorized Official - Phone:602-288-4898
Mailing Address - Street 1:690 N COFCO CENTER CT
Mailing Address - Street 2:290
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-6462
Mailing Address - Country:US
Mailing Address - Phone:602-631-3161
Mailing Address - Fax:602-631-3162
Practice Address - Street 1:690 N COFCO CENTER CT
Practice Address - Street 2:290
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-6462
Practice Address - Country:US
Practice Address - Phone:602-631-3161
Practice Address - Fax:602-631-3162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ69524Medicare ID - Type UnspecifiedMEDICARE ID