1215204383 NPI number — BEN-ORA, HANSEN & VANESIAN IMAGING

Table of content: (NPI 1215204383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215204383 NPI number — BEN-ORA, HANSEN & VANESIAN IMAGING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEN-ORA, HANSEN & VANESIAN IMAGING
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:
SOLIS BENORA MAMMOGRAPHY
Provider Other Organization Name Type Code:
3
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:
1215204383
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15601 DALLAS PKWY
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
ADDISON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75001-3353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-398-4100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5310 W THUNDERBIRD RD
Provider Second Line Business Practice Location Address:
#213
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85306-4706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-439-1472
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KEHM
Authorized Official First Name:
NATALIE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
602-439-1472

Provider Taxonomy Codes

  • Taxonomy code: 261QR0206X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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