Healthcare Provider Details

I. General information

NPI: 1144704610
Provider Name (Legal Business Name): IMAGING ADVANCED CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4566 E INVERNESS AVE STE 102
MESA AZ
85206-4633
US

IV. Provider business mailing address

2853 E LA COSTA DR
GILBERT AZ
85298-2802
US

V. Phone/Fax

Practice location:
  • Phone: 214-295-6703
  • Fax: 214-245-5267
Mailing address:
  • Phone: 480-308-7718
  • Fax: 480-308-7717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEZ CLARK
Title or Position: OWNER
Credential:
Phone: 408-231-4853