Healthcare Provider Details

I. General information

NPI: 1376075077
Provider Name (Legal Business Name): SMI IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 W SOUTHERN AVE BLDG C
APACHE JUNCTION AZ
85120-7455
US

IV. Provider business mailing address

6900 E CAMELBACK RD SUITE #700
SCOTTSDALE AZ
85251-2431
US

V. Phone/Fax

Practice location:
  • Phone: 480-474-5960
  • Fax: 602-302-5861
Mailing address:
  • Phone: 602-651-1945
  • Fax: 602-302-5706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: TRACY PRINCE
Title or Position: PHYSICIANS ONBOARDING MANAGER
Credential:
Phone: 602-651-1945