Healthcare Provider Details

I. General information

NPI: 1144584814
Provider Name (Legal Business Name): PHYSICIANS CHOICE NEURO DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2813 E CAMELBACK RD STE 430
PHOENIX AZ
85016-4337
US

IV. Provider business mailing address

2813 E CAMELBACK RD STE 430
PHOENIX AZ
85016-4337
US

V. Phone/Fax

Practice location:
  • Phone: 602-595-7795
  • Fax: 600-259-5779
Mailing address:
  • Phone: 602-595-7795
  • Fax: 602-595-7796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VICKI BELT
Title or Position: MANAGER
Credential:
Phone: 602-595-7795