Healthcare Provider Details

I. General information

NPI: 1568087187
Provider Name (Legal Business Name): ARIZONA IMAGING SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 E BETHANY HOME RD STE A106
PHOENIX AZ
85014-2192
US

IV. Provider business mailing address

727 E BETHANY HOME RD STE A106
PHOENIX AZ
85014-2192
US

V. Phone/Fax

Practice location:
  • Phone: 602-368-0458
  • Fax:
Mailing address:
  • Phone: 602-368-0458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. NICOLE FEIGENBUTZ
Title or Position: TECHNICAL MANAGER
Credential: RVT
Phone: 602-368-0458