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	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1417403304
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	:	1313 W SAINT MARYS RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-3112
Country	:	US
Telephone Number	:	520-449-8115
Fax Number	:	520-622-1185

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

Provider Enumeration Date	:	08/30/2016
Last Update Date	:	08/30/2016

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