1437575776 NPI number — AZ IMAGING, LLC

Table of content: (NPI 1437575776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437575776 NPI number — AZ IMAGING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AZ 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:
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:
1437575776
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20118 N 67TH AVE
Provider Second Line Business Mailing Address:
SUITE 300-616
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85308-4621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-299-8787
Provider Business Mailing Address Fax Number:
888-965-5094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20118 N 67TH AVE
Provider Second Line Business Practice Location Address:
SUITE 300-616
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85308-4621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-299-8787
Provider Business Practice Location Address Fax Number:
888-965-5094
Provider Enumeration Date:
03/11/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HUNTER
Authorized Official First Name:
DREW
Authorized Official Middle Name:
CLIFFORD
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
623-299-8787

Provider Taxonomy Codes

  • Taxonomy code: 2085U0001X , with the licence number:  L19091486 , 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)