Healthcare Provider Details

I. General information

NPI: 1730266776
Provider Name (Legal Business Name): TUCSON CARDIOVASCULAR IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4790 E CAMP LOWELL DR
TUCSON AZ
85712-1275
US

IV. Provider business mailing address

PO BOX 43100
TUCSON AZ
85733-3100
US

V. Phone/Fax

Practice location:
  • Phone: 520-325-4198
  • Fax: 520-881-3220
Mailing address:
  • Phone: 520-722-3777
  • Fax: 520-296-6224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberAZ18426
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS AURIELLE SUZAN FLASSCHOEN
Title or Position: OFFICE SUPERVISOR
Credential:
Phone: 520-325-4198