Healthcare Provider Details

I. General information

NPI: 1730132036
Provider Name (Legal Business Name): NORTHWEST RANCHO VISTOSO IMAGING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 W ORANGE GROVE
TUCSON AZ
85741
US

IV. Provider business mailing address

PO BOX 36446
TUCSON AZ
85740-6446
US

V. Phone/Fax

Practice location:
  • Phone: 520-469-8960
  • Fax:
Mailing address:
  • Phone: 520-469-8960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License NumberOTC-2709
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURIE HOLTSFORD
Title or Position: DIRECTOR, BUSINESS OFFICE SERVICES
Credential:
Phone: 615-465-7466