1932421591 NPI number — SMI IMAGING LLC

Table of content: (NPI 1932421591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932421591 NPI number — SMI IMAGING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMI IMAGING LLC
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:
SIMONMED IMAGING - PEORIA TOWNE CENTER
Provider Other Organization Name Type Code:
5
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:
1932421591
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6900 E CAMELBACK RD STE 700
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85251-2400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-306-6949
Provider Business Mailing Address Fax Number:
602-302-5706

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9125 W THUNDERBIRD RD STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85381-4921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-234-8725
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/24/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SIMON
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
480-478-6545

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  OTC4845 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 541914 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".