1396703690 NPI number — AZTECH RADIOLOGY AND OPEN MRI

Table of content: (NPI 1396703690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396703690 NPI number — AZTECH RADIOLOGY AND OPEN MRI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AZTECH RADIOLOGY AND OPEN MRI
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:
1396703690
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2653 W GUADALUPE RD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85202-7200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-889-3500
Provider Business Mailing Address Fax Number:
480-889-3502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1840 W APACHE TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APACHE JUNCTION
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85220-3728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-288-6400
Provider Business Practice Location Address Fax Number:
480-889-3501
Provider Enumeration Date:
05/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PAHWA
Authorized Official First Name:
RAKESH
Authorized Official Middle Name:
Authorized Official Title or Position:
CHAIRMAN CEO
Authorized Official Telephone Number:
480-706-1096

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 431221 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: AZ0830070 . This is a "BLUE CROSS BLUE SHIELD GR" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 470001313 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".