Provider Demographics
NPI:1558703405
Name:ADVANVED INJURY MEDICAL, PLLC
Entity Type:Organization
Organization Name:ADVANVED INJURY MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:R
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-224-7556
Mailing Address - Street 1:4252 N VERRADO WAY
Mailing Address - Street 2:SUITE.203
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-7586
Mailing Address - Country:US
Mailing Address - Phone:623-224-7556
Mailing Address - Fax:
Practice Address - Street 1:4252 N VERRADO WAY
Practice Address - Street 2:SUITE.203
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85396-7586
Practice Address - Country:US
Practice Address - Phone:623-224-7556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-20
Last Update Date:2013-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care