Basic Information
| Provider Information | |||||||||
| NPI: | 1750802807 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ELLSWORTH | ||||||||
| FirstName: | CURTIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4951 S WHITE MOUNTAIN RD BLDG A | ||||||||
| Address2: | |||||||||
| City: | SHOW LOW | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859017827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285376700 | ||||||||
| FaxNumber: | 9285370033 | ||||||||
| Practice Location | |||||||||
| Address1: | SUMMIT HEALTHCARE ORTHOPEDIC SURGERY | ||||||||
| Address2: | 4951 S WHITE MOUNTAIN RD, BLDG A | ||||||||
| City: | SHOW LOW | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285376700 | ||||||||
| FaxNumber: | 9285370033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2017 | ||||||||
| LastUpdateDate: | 07/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 2017019588 | MO | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 009627 | AZ | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.