1821056367 NPI number — AZTECH RADIOLOGY AND OPEN MRI

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821056367 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:
1821056367
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2007
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:
480-889-3501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 E MCDOWELL RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85006-2621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-265-8800
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: APPLICATION PENDING , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 470001313 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0830070 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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