1992938153 NPI number — SMI IMAGING, LLC

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 1992938153 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:
Provider Other Organization Name Type Code:
6
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:
1992938153
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7368
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92863-7368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-571-5000
Provider Business Mailing Address Fax Number:
714-571-5055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
235 S DOBSON RD BLDG L
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85224-6229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-264-2300
Provider Business Practice Location Address Fax Number:
480-264-2310
Provider Enumeration Date:
09/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SIMON
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
480-264-2400

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  OTC4687 , 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: 473857 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00811052 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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