Provider Demographics
NPI:1871723866
Name:AZ ORTHO PA PLLC
Entity type:Organization
Organization Name:AZ ORTHO PA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SPICER
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:480-510-2818
Mailing Address - Street 1:7119 E SHEA BLVD
Mailing Address - Street 2:SUITE 109-233
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6107
Mailing Address - Country:US
Mailing Address - Phone:480-510-2818
Mailing Address - Fax:
Practice Address - Street 1:20201 N SCOTTSDALE HEALTHCARE DR
Practice Address - Street 2:SUITE 280
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4134
Practice Address - Country:US
Practice Address - Phone:480-473-3668
Practice Address - Fax:480-473-3671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3580363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ167289Medicaid
AZ167289Medicaid