Healthcare Provider Details

I. General information

NPI: 1972100063
Provider Name (Legal Business Name): ARIZONA IMAGING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 10/02/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10825 W MCDOWELL RD SUITE 130
AVONDALE AZ
85392
US

IV. Provider business mailing address

PO BOX 41638
PHOENIX AZ
85080-1638
US

V. Phone/Fax

Practice location:
  • Phone: 844-900-2567
  • Fax:
Mailing address:
  • Phone: 844-900-2567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY COZATT
Title or Position: INVESTOR RELATIONS OFFICER
Credential:
Phone: 480-395-8211