Healthcare Provider Details

I. General information

NPI: 1245993096
Provider Name (Legal Business Name): FEDERAL INJURY CLINICS OF ARIZONA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 E BASELINE RD STE 100
GILBERT AZ
85234-2467
US

IV. Provider business mailing address

2451 E BASELINE RD STE 100
GILBERT AZ
85234-2467
US

V. Phone/Fax

Practice location:
  • Phone: 480-304-5152
  • Fax: 480-603-4147
Mailing address:
  • Phone: 480-304-5152
  • Fax: 480-603-4147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FARID ROOH
Title or Position: CEO
Credential: DC
Phone: 480-717-2008