Healthcare Provider Details

I. General information

NPI: 1740587534
Provider Name (Legal Business Name): NORTH MOUNTAIN IMAGING SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2011
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19636 N 27TH AVE SUITE LL1
PHOENIX AZ
85027-4013
US

IV. Provider business mailing address

PO BOX 9907
PHOENIX AZ
85068-0907
US

V. Phone/Fax

Practice location:
  • Phone: 623-780-3751
  • Fax:
Mailing address:
  • Phone: 623-780-3751
  • Fax:

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: FACHE
Phone: 623-780-3751