Provider Demographics
NPI:1992405203
Name:INJURY CENTER OF AZ PLLC
Entity type:Organization
Organization Name:INJURY CENTER OF AZ PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:SUSANA
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD-MPH
Authorized Official - Phone:480-248-5787
Mailing Address - Street 1:14251 N 6TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4224
Mailing Address - Country:US
Mailing Address - Phone:480-248-5787
Mailing Address - Fax:
Practice Address - Street 1:1331 N 7TH ST STE 355
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2772
Practice Address - Country:US
Practice Address - Phone:480-248-5787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty