Healthcare Provider Details

I. General information

NPI: 1033498399
Provider Name (Legal Business Name): BREAST IMAGING SPECIALISTS OF ARIZONA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19646 N 27TH AVE STE. 205
PHOENIX AZ
85027-4017
US

IV. Provider business mailing address

2500 W UTOPIA RD STE. 100
PHOENIX AZ
85027-4171
US

V. Phone/Fax

Practice location:
  • Phone: 623-780-4673
  • Fax: 623-434-2789
Mailing address:
  • Phone: 623-780-3751
  • Fax: 623-780-3752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NATHAN ANSPACH
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 623-780-3751