MEDICARE: SMI IMAGING, 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	261Q00000X	Clinic/Center
2	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1255870267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMI IMAGING, LLC

Provider Business Mailing Address
First Line	:	6900 E CAMELBACK RD
Second Line	:	SUITE #700
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-2431
Country	:	US
Telephone Number	:	602-651-1945
Fax Number	:	602-302-5706

Provider Business Practice Location Address
First Line	:	4219 E BELL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-3366
Country	:	US
Telephone Number	:	480-584-5525
Fax Number	:	602-302-5860

Authorized Official
Title or Position	:	PHYSICIANS ONBOARDING MANAGER
Name	:	TRACY PRINCE
Credential	:
Telephone Number	:	602-651-1945

Provider Enumeration Date	:	02/23/2017
Last Update Date	:	02/23/2017

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