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

Table of content: TERESA LADNER NP (NPI 1821731944)

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)