Healthcare Provider Details

I. General information

NPI: 1578874533
Provider Name (Legal Business Name): ARIZONA FAMILY CARE ASSOCIATES IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 EL CAMINO REAL SUITE 11F
SIERRA VISTA AZ
85635-2860
US

IV. Provider business mailing address

6 S 2ND ST
SIERRA VISTA AZ
85635-1830
US

V. Phone/Fax

Practice location:
  • Phone: 520-417-4318
  • Fax: 520-417-4279
Mailing address:
  • Phone: 520-458-4335
  • Fax: 520-458-2988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: FRED B WILLIAMS
Title or Position: CEO
Credential: ED.D.
Phone: 520-458-4335