Provider Demographics
NPI:1811109879
Name:ARIZONA ARTHROSCOPY & SPORTS MEDICINE, LTD
Entity type:Organization
Organization Name:ARIZONA ARTHROSCOPY & SPORTS MEDICINE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PEAIRS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-971-7073
Mailing Address - Street 1:PO BOX 30305
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85046-0305
Mailing Address - Country:US
Mailing Address - Phone:602-971-7073
Mailing Address - Fax:602-971-1706
Practice Address - Street 1:4550 E BELL RD
Practice Address - Street 2:BLDG 8 SUITE 276
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-9306
Practice Address - Country:US
Practice Address - Phone:602-971-7073
Practice Address - Fax:602-971-1706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15437207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWDCBJMedicare PIN