Basic Information
Provider Information
NPI: 1316260425
EntityType: 2
ReplacementNPI:  
OrganizationName: OSNA PLLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: ORTHOARIZONA
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 271429
Address2:  
City: SALT LAKE CITY
State: UT
PostalCode: 841271429
CountryCode: US
TelephoneNumber: 6027723800
FaxNumber: 6027723801
Practice Location
Address1: 8630 E VIA DE VENTURA
Address2: SUITE 201
City: SCOTTSDALE
State: AZ
PostalCode: 852583358
CountryCode: US
TelephoneNumber: 4805583744
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/03/2010
LastUpdateDate: 01/04/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: ENGLERT
AuthorizedOfficialFirstName: MELISSA
AuthorizedOfficialMiddleName: A
AuthorizedOfficialTitleorPosition: CREDENTIALING COORDINATOR
AuthorizedOfficialTelephone: 6023852115
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: ORTHOPEDIC SPECIALISTS OF NORTH AMERICA
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOrthopaedic Surgery 

ID Information
IDTypeStateIssuerDescription
DQ450101AZRAILROAD MEDICARE PTANOTHER
641982002301AZNATIONAL SUPPLIER CLEARING HOUSEOTHER
71553505AZ MEDICAID


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