Provider Demographics
NPI:1801808746
Name:SIERRA ORTHOPEDICS, PC
Entity type:Organization
Organization Name:SIERRA ORTHOPEDICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-836-8988
Mailing Address - Street 1:1780 E FLORENCE BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-4782
Mailing Address - Country:US
Mailing Address - Phone:520-836-8988
Mailing Address - Fax:520-836-7930
Practice Address - Street 1:1780 E FLORENCE BLVD STE 106
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4782
Practice Address - Country:US
Practice Address - Phone:520-836-8988
Practice Address - Fax:520-836-7930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
200014460OtherRR MCR ID #
1801808746OtherGROUP NPI
200018015OtherRR MCR ID
DB7999OtherRR MCR GROUP #
200018015OtherRR MCR ID