MEDICARE: INJURY CENTERS OF ARIZONA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0117X	Orthopaedic Surgery of the Spine Physician

General Provider Information

NPI Number	:	1639825177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INJURY CENTERS OF ARIZONA LLC

Provider Business Mailing Address
First Line	:	13575 W INDIAN SCHOOL RD STE 700
Second Line	:
City	:	LITCHFIELD PARK
State	:	AZ
Zip	:	85340-4905
Country	:	US
Telephone Number	:	623-663-2410
Fax Number	:	623-663-2411

Provider Business Practice Location Address
First Line	:	13575 W INDIAN SCHOOL RD STE 700
Second Line	:
City	:	LITCHFIELD PARK
State	:	AZ
Zip	:	85340-4905
Country	:	US
Telephone Number	:	623-663-2410
Fax Number	:	623-663-2411

Authorized Official
Title or Position	:	ASSISTANT MANAGER
Name	:	CHRISTOPHER ARMSTRONG
Credential	:
Telephone Number	:	623-663-2410

Provider Enumeration Date	:	02/23/2022
Last Update Date	:	02/23/2022

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