MEDICARE: PREMIER SPORTS IMAGING INC

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	27471	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0782750	OTHER	AZ	BCBSAZ
2	2Z3264	OTHER	AZ	HEALTH NET OF AZ
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962466722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER SPORTS IMAGING INC

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	:	7111 W BELL RD
Second Line	:	SUITE 104
City	:	GLENDALE
State	:	AZ
Zip	:	85308-8551
Country	:	US
Telephone Number	:	623-533-4465
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PERRY S HISCOK
Credential	:	M.D.
Telephone Number	:	602-943-9200

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	01/06/2012

Similar Medicare Providers

1689524043 — JADE ULMER
Practice Location Address:

7111 W BELL RD STE 101-103
GLENDALE, AZ
85308-8551

Practice Phone: 855-223-7123
Practice Fax: 619-374-7134

1982555033 — JOLISA WHITE
Practice Location Address:

7111 W BELL RD STE 101-103
GLENDALE, AZ
85308-8551

Practice Phone: 855-223-7123
Practice Fax: 619-374-7134

1003870726 — DR. PERRY S HISCOK M.D.
Practice Location Address:

7111 W BELL RD , SUITE 104
GLENDALE, AZ
85308-8551

Practice Phone: 623-533-4465
Practice Fax:

1619523875 — GEMA CASTILLO
Practice Location Address:

7111 W BELL RD
GLENDALE, AZ
85308-8551

Practice Phone: 855-223-7213
Practice Fax:

1568331874 — CHRISTINA FANDINO GOBERT
Practice Location Address:

7111 W BELL RD STE 101-103
GLENDALE, AZ
85308-8551

Practice Phone: 855-223-7123
Practice Fax: 619-374-7134

1326908054 — SUMMER JANELL BOREN RADJEVIC
Practice Location Address:

7111 W BELL RD STE 101-103
GLENDALE, AZ
85308-8551

Practice Phone: 855-223-7123
Practice Fax: 619-374-7134

Directions to “PREMIER SPORTS IMAGING INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.