Healthcare Provider Details

I. General information

NPI: 1114668779
Provider Name (Legal Business Name): WORK INJURY AND ACCIDENT TREATMENT CLINICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11030 N TATUM BLVD STE 101
PHOENIX AZ
85028-6073
US

IV. Provider business mailing address

11030 N TATUM BLVD STE 101
PHOENIX AZ
85028-6073
US

V. Phone/Fax

Practice location:
  • Phone: 602-889-9878
  • Fax:
Mailing address:
  • Phone: 602-889-9878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES SIEFFERT
Title or Position: MEMBER
Credential: DC
Phone: 480-205-9447