Healthcare Provider Details

I. General information

NPI: 1144521741
Provider Name (Legal Business Name): NRS ARIZONA, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1397 WELMER ROAD
TAOS NM
87571-6253
US

IV. Provider business mailing address

4900 N SCOTTSDALE RD
SCOTTSDALE AZ
85251-7652
US

V. Phone/Fax

Practice location:
  • Phone: 575-758-8883
  • Fax:
Mailing address:
  • Phone: 208-292-2258
  • Fax:

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: TIMOTHY MYERS
Title or Position: PRESIDENT
Credential: MD
Phone: 208-292-2258