1164460077 NPI number — SIMONMED IMAGING, INCORPORATED

Table of content: (NPI 1164460077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164460077 NPI number — SIMONMED IMAGING, INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIMONMED IMAGING, INCORPORATED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164460077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6900 EAST CAMELBACK ROAD
Provider Second Line Business Mailing Address:
SUITE 700
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-809-4829
Provider Business Mailing Address Fax Number:
623-322-6147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9201 EAST MOUNTAIN VIEW ROAD
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85258-5140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-714-6160
Provider Business Practice Location Address Fax Number:
602-714-6161
Provider Enumeration Date:
06/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SIMON
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
480-809-4829

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AZ0729440 . This is a "BCBS IDENTIFIER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 0763418 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 763418 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".