Healthcare Provider Details

I. General information

NPI: 1063403616
Provider Name (Legal Business Name): MRI OF ARIZONA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W GLENDALE AVE
PHOENIX AZ
85021-8629
US

IV. Provider business mailing address

701 W GLENDALE AVE
PHOENIX AZ
85021-8629
US

V. Phone/Fax

Practice location:
  • Phone: 602-294-9009
  • Fax: 602-294-9012
Mailing address:
  • Phone: 602-294-9009
  • Fax: 602-294-9012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberOTC 3586
License Number StateAZ

VIII. Authorized Official

Name: MR. STEVE BORTA
Title or Position: PRESIDENT
Credential:
Phone: 602-294-9009