Healthcare Provider Details

I. General information

NPI: 1689317497
Provider Name (Legal Business Name): SIMONMED IMAGING FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 N DALE MABRY HWY STE 150
TAMPA FL
33618-4469
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 813-964-8439
  • Fax: 813-964-0908
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/OWNER
Credential: MD
Phone: 602-809-6623