MEDICARE: MODERN DIAGNOSTIC IMAGING, P.C.

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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1447588421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODERN DIAGNOSTIC IMAGING, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 27340
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85061-7340
Country	:	US
Telephone Number	:	602-943-9200
Fax Number	:	602-216-3000

Provider Business Practice Location Address
First Line	:	606 N COUNTRY CLUB DR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-5700
Country	:	US
Telephone Number	:	480-445-9961
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SHEETAL G. MEHTA
Credential	:
Telephone Number	:	480-445-9961

Provider Enumeration Date	:	12/02/2009
Last Update Date	:	12/02/2009

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