Healthcare Provider Details

I. General information

NPI: 1285579425
Provider Name (Legal Business Name): ULTRASCAN X-RAY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S YALE ST STE 152
FLAGSTAFF AZ
86001-7337
US

IV. Provider business mailing address

1501 S YALE ST STE 152
FLAGSTAFF AZ
86001-7337
US

V. Phone/Fax

Practice location:
  • Phone: 254-747-5243
  • Fax:
Mailing address:
  • Phone: 254-747-5243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. RENATA YAZZIE
Title or Position: MANAGER
Credential:
Phone: 254-747-5243