Healthcare Provider Details

I. General information

NPI: 1760733455
Provider Name (Legal Business Name): SMI IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2012
Last Update Date: 09/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S DOBSON RD SUITE 105
CHANDLER AZ
85224-5680
US

IV. Provider business mailing address

PO BOX 7368
ORANGE CA
92863-7368
US

V. Phone/Fax

Practice location:
  • Phone: 480-812-1705
  • Fax: 480-812-1706
Mailing address:
  • Phone: 714-571-5000
  • Fax: 714-571-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. HOWARD J SIMON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-571-5000