Healthcare Provider Details

I. General information

NPI: 1033596770
Provider Name (Legal Business Name): SMI IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 05/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6707 N 19TH AVE SUITE 101
PHOENIX AZ
85015-1104
US

IV. Provider business mailing address

6900 E CAMELBACK RD SUITE # 101
SCOTTSDALE AZ
85251-2431
US

V. Phone/Fax

Practice location:
  • Phone: 602-242-4177
  • Fax: 602-242-4022
Mailing address:
  • Phone: 602-651-1945
  • Fax: 602-302-5706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateAZ

VIII. Authorized Official

Name: DR. HOWARD J SIMON
Title or Position: CEO
Credential: MD
Phone: 602-242-4177