Provider Demographics
NPI:1447530027
Name:ARIZONA INJURY MEDICAL ASSOCIATES, P.L.L.C.
Entity type:Organization
Organization Name:ARIZONA INJURY MEDICAL ASSOCIATES, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEMITRI
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADARMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-347-0941
Mailing Address - Street 1:PO BOX 5277
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98509-5277
Mailing Address - Country:US
Mailing Address - Phone:480-347-0941
Mailing Address - Fax:480-222-7074
Practice Address - Street 1:4840 E INDIAN SCHOOL RD
Practice Address - Street 2:SUITE 104
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5500
Practice Address - Country:US
Practice Address - Phone:480-347-0941
Practice Address - Fax:480-222-7074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44737208100000X
AZ451852084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty