MEDICARE: SOUTHWEST ACCIDENT & INJURY MEDICAL CENTER ,II LTD

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	207Q00000X	Family Medicine Physician	2479	AZ

General Provider Information

NPI Number	:	1942307921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST ACCIDENT & INJURY MEDICAL CENTER ,II LTD

Provider Business Mailing Address
First Line	:	1820 W MARYLAND AVE
Second Line	:	SUITE 5
City	:	PHOENIX
State	:	AZ
Zip	:	85015-1740
Country	:	US
Telephone Number	:	602-242-4100
Fax Number	:	602-242-7965

Provider Business Practice Location Address
First Line	:	1820 W MARYLAND AVE
Second Line	:	SUITE 5
City	:	PHOENIX
State	:	AZ
Zip	:	85015-1740
Country	:	US
Telephone Number	:	602-242-4100
Fax Number	:	602-242-7965

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK P SIEGEL
Credential	:	D.O.
Telephone Number	:	602-242-4100

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	03/13/2009

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