Healthcare Provider Details

I. General information

NPI: 1336409200
Provider Name (Legal Business Name): SMI IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 N 3RD ST SUITE 102
PHOENIX AZ
85004-1153
US

IV. Provider business mailing address

PO BOX 7368
ORANGE CA
92863-7368
US

V. Phone/Fax

Practice location:
  • Phone: 602-234-2994
  • Fax: 602-648-5588
Mailing address:
  • Phone: 714-571-5000
  • Fax: 714-571-5055

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: DR. HOWARD J SIMON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 480-264-2400