Provider Demographics
NPI:1639788284
Name:ARIZONA BIOLOGIC INFUSION LLC
Entity Type:Organization
Organization Name:ARIZONA BIOLOGIC INFUSION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AMER
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-KHOUDARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-815-1100
Mailing Address - Street 1:604 W WARNER RD STE C4
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2906
Mailing Address - Country:US
Mailing Address - Phone:480-372-8200
Mailing Address - Fax:480-372-8222
Practice Address - Street 1:604 W WARNER RD STE C4
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2906
Practice Address - Country:US
Practice Address - Phone:480-372-8200
Practice Address - Fax:480-372-8222
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARIZONA ARTHRITIS CLINIC,PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-29
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ069024Medicaid
AZ002601Medicaid
AZ092299Medicaid