Provider Demographics
NPI:1215033873
Name:CHANDLER ACCIDENT AND INJURY MEDICAL CENTERS
Entity Type:Organization
Organization Name:CHANDLER ACCIDENT AND INJURY MEDICAL CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:P
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-242-4100
Mailing Address - Street 1:2175 N ALMA SCHOOL RD
Mailing Address - Street 2:SUITE B-101
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-2878
Mailing Address - Country:US
Mailing Address - Phone:480-722-0799
Mailing Address - Fax:480-722-0798
Practice Address - Street 1:2175 N ALMA SCHOOL RD
Practice Address - Street 2:SUITE B-101
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2878
Practice Address - Country:US
Practice Address - Phone:480-722-0799
Practice Address - Fax:480-722-0798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ111147Medicare UPIN