Provider Demographics
NPI:1114623246
Name:ARIZONA SPORTS MEDICINE PLLC
Entity Type:Organization
Organization Name:ARIZONA SPORTS MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:VEATCH
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:480-438-0069
Mailing Address - Street 1:2034 E SOUTHERN AVE STE K
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7511
Mailing Address - Country:US
Mailing Address - Phone:480-400-6225
Mailing Address - Fax:
Practice Address - Street 1:2034 E SOUTHERN AVE STE K
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7511
Practice Address - Country:US
Practice Address - Phone:480-400-6225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty