Provider Demographics
NPI:1942307921
Name:SOUTHWEST ACCIDENT & INJURY MEDICAL CENTER ,II LTD
Entity Type:Organization
Organization Name:SOUTHWEST ACCIDENT & INJURY MEDICAL CENTER ,II LTD
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 1:1820 W MARYLAND AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-1740
Mailing Address - Country:US
Mailing Address - Phone:602-242-4100
Mailing Address - Fax:602-242-7965
Practice Address - Street 1:1820 W MARYLAND AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-1740
Practice Address - Country:US
Practice Address - Phone:602-242-4100
Practice Address - Fax:602-242-7965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2479207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE18134Medicare UPIN