| Impactmedical, LLC | |
|
701 W Glendale Ave Phoenix AZ 85021-8629 | |
| (602) 762-1128 | |
| Not Available |
| Full Name | Impactmedical, LLC |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 701 W Glendale Ave, Phoenix, Arizona |
| Authorized Official Name and Position | Matthew Coen (DIRECTOR) |
| Authorized Official Contact | 6027621128 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Impactmedical, LLC 7000 N 16th St Ste 102-201 Phoenix AZ 85020-5512 Ph: (602) 762-1128 | Impactmedical, LLC 701 W Glendale Ave Phoenix AZ 85021-8629 Ph: (602) 762-1128 |
| NPI Number | 1790387694 |
|---|---|
| Provider Enumeration Date | 11/15/2020 |
| Last Update Date | 11/15/2020 |
| Certification Date | 11/15/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790387694 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | () | Primary |
| 261QR0400X | Clinic/center - Rehabilitation | () | Secondary |
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