Basic Information
| Provider Information | |||||||||
| NPI: | 1215335989 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARIZONA MEDICAL & INJURY, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3655 W ANTHEM WAY | ||||||||
| Address2: | A109 BOX 272 | ||||||||
| City: | ANTHEM | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850860430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023950718 | ||||||||
| FaxNumber: | 6023437973 | ||||||||
| Practice Location | |||||||||
| Address1: | 3655 W ANTHEM WAY | ||||||||
| Address2: | A109 BOX 272 | ||||||||
| City: | ANTHEM | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850860430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023950718 | ||||||||
| FaxNumber: | 6023437973 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2014 | ||||||||
| LastUpdateDate: | 12/12/2014 | ||||||||
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| AuthorizedOfficialLastName: | STAMP | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6023950718 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 7346 | AZ | N | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | 208VP0000X | 7346 | AZ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.