Provider Demographics
NPI:1780409961
Name:INJURY CENTER OF ARIZONA, LLC
Entity type:Organization
Organization Name:INJURY CENTER OF ARIZONA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSS-RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-998-5800
Mailing Address - Street 1:1406 W CAMELBACK RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013
Mailing Address - Country:US
Mailing Address - Phone:480-525-1047
Mailing Address - Fax:602-581-3000
Practice Address - Street 1:1406 W CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013
Practice Address - Country:US
Practice Address - Phone:480-525-1047
Practice Address - Fax:602-581-3000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty