Provider Demographics
NPI:1932348851
Name:SAN TAN ORTHOPEDICS, PLC
Entity type:Organization
Organization Name:SAN TAN ORTHOPEDICS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MYERTHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-678-5186
Mailing Address - Street 1:4411 N 24TH WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4972
Mailing Address - Country:US
Mailing Address - Phone:480-678-5186
Mailing Address - Fax:602-685-9595
Practice Address - Street 1:4411 N 24TH WAY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4972
Practice Address - Country:US
Practice Address - Phone:480-678-5186
Practice Address - Fax:602-685-9595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29962207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ749559Medicaid
AZH62917Medicare UPIN
AZZ107861Medicare PIN