Healthcare Provider Details

I. General information

NPI: 1053633453
Provider Name (Legal Business Name): INTEGRATED DIAGNOSTIC SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6929 N HAYDEN RD C4-220
SCOTTSDALE AZ
85250-7978
US

IV. Provider business mailing address

6929 N HAYDEN RD C4-220
SCOTTSDALE AZ
85250-7978
US

V. Phone/Fax

Practice location:
  • Phone: 480-495-5644
  • Fax:
Mailing address:
  • Phone: 480-495-5644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: CRAIG C HAMELINK
Title or Position: MEMBER
Credential:
Phone: 480-495-5644