Provider Demographics
NPI:1831545417
Name:ORTHOPEDIC SURGERY ASSISTANTS, LLC
Entity type:Organization
Organization Name:ORTHOPEDIC SURGERY ASSISTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAC, OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CANTWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:602-908-2025
Mailing Address - Street 1:20235 N CAVE CREEK RD
Mailing Address - Street 2:STE. 104-239
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-4424
Mailing Address - Country:US
Mailing Address - Phone:602-908-2025
Mailing Address - Fax:
Practice Address - Street 1:9003 E SHEA BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6709
Practice Address - Country:US
Practice Address - Phone:602-908-2025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-12
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3145363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty