Healthcare Provider Details

I. General information

NPI: 1790395739
Provider Name (Legal Business Name): INJURY MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 N HAYDEN RD STE 210
SCOTTSDALE AZ
85251-6651
US

IV. Provider business mailing address

3260 N HAYDEN RD STE 210
SCOTTSDALE AZ
85251-6651
US

V. Phone/Fax

Practice location:
  • Phone: 480-542-5590
  • Fax: 480-542-5591
Mailing address:
  • Phone: 480-542-5590
  • Fax: 480-542-5591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW RHODES
Title or Position: MANAGING MEMBER
Credential: NP
Phone: 480-542-5590