Healthcare Provider Details

I. General information

NPI: 1245552132
Provider Name (Legal Business Name): SMI IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 W PEORIA AVE STE B301
PHOENIX AZ
85029-4618
US

IV. Provider business mailing address

6900 E CAMELBACK RD STE 700
SCOTTSDALE AZ
85251-2400
US

V. Phone/Fax

Practice location:
  • Phone: 602-688-6120
  • Fax:
Mailing address:
  • Phone: 480-306-6949
  • Fax: 602-302-5706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberOTC4881
License Number StateAZ

VIII. Authorized Official

Name: HOWARD JOHN SIMON
Title or Position: CEO
Credential: MD
Phone: 480-478-6545