1154832277 NPI number — ACCIDENT & INJURY SOLUTIONS Dr. Aaron Randall DeGroot Doctor of Osteopathic Medicine

Table of content: Dr. Aaron Randall DeGroot Doctor of Osteopathic Medicine (NPI 1154832277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154832277 NPI number — ACCIDENT & INJURY SOLUTIONS Dr. Aaron Randall DeGroot Doctor of Osteopathic Medicine

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCIDENT & INJURY SOLUTIONS
Provider Last Name:
DeGroot
Provider First Name:
Aaron
Provider Middle Name:
Randall
Provider Name Prefix Text:
Dr.
Provider Name Suffix Text:
Provider Credential Text:
Doctor of Osteopathic Medicine
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154832277
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 75573
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85087-1029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-466-9664
Provider Business Mailing Address Fax Number:
602-391-2617

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 W GLENDALE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85021-8629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-466-9664
Provider Business Practice Location Address Fax Number:
602-391-2617
Provider Enumeration Date:
10/16/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DEGROOT
Authorized Official First Name:
JOJO
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
602-466-9664

Provider Taxonomy Codes

  • Taxonomy code: 204C00000X , with the licence number:  4105 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QS0010X , with the licence number: 4105 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)