Healthcare Provider Details

I. General information

NPI: 1487618013
Provider Name (Legal Business Name): CAMELBACK IMAGING HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15215 S 48TH ST BUILDING 1 SUITE 110
PHOENIX AZ
85044-9142
US

IV. Provider business mailing address

PO BOX 98341
PHOENIX AZ
85038-0341
US

V. Phone/Fax

Practice location:
  • Phone: 480-940-9729
  • Fax: 480-940-9730
Mailing address:
  • Phone: 602-943-9200
  • Fax: 602-216-3000

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. JORDAN K COHEN
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 602-943-9200