Healthcare Provider Details

I. General information

NPI: 1891928107
Provider Name (Legal Business Name): SMI IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 05/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20414 N 27TH AVE STE 150
PHOENIX AZ
85027-3246
US

IV. Provider business mailing address

PO BOX 7368
ORANGE CA
92863-7368
US

V. Phone/Fax

Practice location:
  • Phone: 623-234-2520
  • Fax: 623-234-2530
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 NumberOTC4685
License Number StateAZ

VIII. Authorized Official

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