Healthcare Provider Details

I. General information

NPI: 1417091158
Provider Name (Legal Business Name): ARISTA IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 E MCKELLIPS RD
MESA AZ
85203-2721
US

IV. Provider business mailing address

PO BOX 1169
ROCKLAND ME
04841-1169
US

V. Phone/Fax

Practice location:
  • Phone: 480-644-9879
  • Fax: 480-644-9879
Mailing address:
  • Phone: 207-593-7501
  • Fax: 207-594-2433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MARTIN FARRELL
Title or Position: MANAGER
Credential:
Phone: 207-593-7501