Provider Demographics
NPI:1467829184
Name:AZ SPORTS CLINIC, LLC
Entity Type:Organization
Organization Name:AZ SPORTS CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:G
Authorized Official - Last Name:SELTZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-547-7502
Mailing Address - Street 1:7797 W. PARADISE LANE SUITE 130
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382
Mailing Address - Country:US
Mailing Address - Phone:623-547-7502
Mailing Address - Fax:623-414-3503
Practice Address - Street 1:7797 W. PARADISE LANE SUITE 130
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85382-3588
Practice Address - Country:US
Practice Address - Phone:623-547-7502
Practice Address - Fax:623-414-3503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty