MEDICARE: MEDICAL IMAGERY NORTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	146525	OTHER	AZ	AHCCCS GROUP BILLER #
2	2Z4780	OTHER	AZ	HEALTH NET OF AZ

General Provider Information

NPI Number	:	1114995875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL IMAGERY NORTH LLC

Provider Business Mailing Address
First Line	:	21031 N CAVE CREEK RD
Second Line	:	SUITE F4
City	:	PHOENIX
State	:	AZ
Zip	:	85024-5525
Country	:	US
Telephone Number	:	602-788-1900
Fax Number	:	602-788-1902

Provider Business Practice Location Address
First Line	:	21031 N CAVE CREEK RD
Second Line	:	SUITE F4
City	:	PHOENIX
State	:	AZ
Zip	:	85024-5525
Country	:	US
Telephone Number	:	602-788-1900
Fax Number	:	602-788-1902

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	MRS. JENNIFER SCHULZE
Credential	:
Telephone Number	:	602-788-1900

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	01/17/2008

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