Healthcare Provider Details

I. General information

NPI: 1922604446
Provider Name (Legal Business Name): SMI IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 12/09/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 E MOUNTAIN VIEW RD STE 112
SCOTTSDALE AZ
85258-5140
US

IV. Provider business mailing address

6900 E CAMELBACK RD STE 700
SCOTTSDALE AZ
85251-2400
US

V. Phone/Fax

Practice location:
  • Phone: 602-714-6160
  • Fax:
Mailing address:
  • Phone: 480-306-6949
  • Fax: 602-302-5706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: HOWARD JOHN SIMON
Title or Position: CEO
Credential: MD
Phone: 480-478-6545