Provider Demographics
NPI:1982700720
Name:CANYON ORTHOPAEDIC SURGEONS
Entity Type:Organization
Organization Name:CANYON ORTHOPAEDIC SURGEONS
Other - Org Name:CANYON ORTHOPAEDIC SURGEONS
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:POINDEXTER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:623-846-7614
Mailing Address - Street 1:10450 W MCDOWELL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-4802
Mailing Address - Country:US
Mailing Address - Phone:623-846-7614
Mailing Address - Fax:623-846-0993
Practice Address - Street 1:10450 W MCDOWELL RD
Practice Address - Street 2:STE 102
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392
Practice Address - Country:US
Practice Address - Phone:623-846-7614
Practice Address - Fax:623-848-4738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ136714OtherEFF 5/1/2010, OSNA GROUP PTAN
AZ1770805590OtherAS OF 5/1/2010, CANYON/OSNA DIVISION NPI
AZ1982700720OtherCANYON GROUP NPI PRIOR TO 5/1/2010
AZ0692950001OtherMEDICARE DMERC (AV)
AZ1770812828OtherEFF 5/1/2010, OSNA GROUP NPI