Healthcare Provider Details

I. General information

NPI: 1194285387
Provider Name (Legal Business Name): APR MED GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10605 N HAYDEN RD STE D102
SCOTTSDALE AZ
85260-5686
US

IV. Provider business mailing address

21001 N TATUM BLVD STE 1630-606
PHOENIX AZ
85050-4242
US

V. Phone/Fax

Practice location:
  • Phone: 602-237-6340
  • Fax:
Mailing address:
  • Phone: 602-354-5310
  • Fax: 480-887-8041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS MOSHIRI
Title or Position: MANAGER
Credential: MD
Phone: 602-441-3573