Provider Demographics
NPI:1245993096
Name:FEDERAL INJURY CLINICS OF ARIZONA, LLC
Entity type:Organization
Organization Name:FEDERAL INJURY CLINICS OF ARIZONA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FARID
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-717-2008
Mailing Address - Street 1:2451 E BASELINE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2467
Mailing Address - Country:US
Mailing Address - Phone:480-304-5152
Mailing Address - Fax:480-603-4147
Practice Address - Street 1:2451 E BASELINE RD STE 100
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2467
Practice Address - Country:US
Practice Address - Phone:480-304-5152
Practice Address - Fax:480-603-4147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies