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	2085R0202X	Diagnostic Radiology Physician	OTC4833	AZ

General Provider Information

NPI Number	:	1457681272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMI IMAGING, LLC

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

Provider Business Practice Location Address
First Line	:	6740 E CAMELBACK RD
Second Line	:	SUITE 100
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-2096
Country	:	US
Telephone Number	:	480-990-1201
Fax Number	:	480-990-1210

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HOWARD J SIMON
Credential	:	M.D.
Telephone Number	:	480-264-2400

Provider Enumeration Date	:	12/29/2009
Last Update Date	:	06/09/2010

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