Healthcare Provider Details

I. General information

NPI: 1154832277
Provider Name (Legal Business Name): ACCIDENT & INJURY SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 10/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W GLENDALE AVE
PHOENIX AZ
85021-8629
US

IV. Provider business mailing address

PO BOX 75573
PHOENIX AZ
85087-1029
US

V. Phone/Fax

Practice location:
  • Phone: 602-466-9664
  • Fax: 602-391-2617
Mailing address:
  • Phone: 602-466-9664
  • Fax: 602-391-2617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomyNeuromusculoskeletal Medicine, Sports Medicine
License Number4105
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine
License Number4105
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice
License Number
License Number State

VIII. Authorized Official

Name: JOJO DEGROOT
Title or Position: ADMINISTRATOR
Credential:
Phone: 602-466-9664