Healthcare Provider Details

I. General information

NPI: 1629612825
Provider Name (Legal Business Name): INJURY IMAGING SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3139 E LINCOLN DR
PHOENIX AZ
85016-2317
US

IV. Provider business mailing address

173 MAIN ST
THOMASTON ME
04861-3807
US

V. Phone/Fax

Practice location:
  • Phone: 602-368-2758
  • Fax:
Mailing address:
  • Phone: 207-706-6810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARTIN FARRELL
Title or Position: CEO
Credential:
Phone: 207-706-6810