Healthcare Provider Details

I. General information

NPI: 1568424315
Provider Name (Legal Business Name): PRESCOTT MEDICAL IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 WHIPPLE ST
PRESCOTT AZ
86301-1606
US

IV. Provider business mailing address

810 WHIPPLE ST
PRESCOTT AZ
86301-1606
US

V. Phone/Fax

Practice location:
  • Phone: 928-771-7577
  • Fax: 928-771-7616
Mailing address:
  • Phone: 928-771-7577
  • Fax: 928-771-7616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: DR. STANLEY RHETT SMITH
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 928-778-1971