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General NPI Number Information
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NPI Number | 1023093135
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Entity Type | Organization
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Legal Business Name | PHOENIX DIAGNOSTIC IMAGING INC
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Dates
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Enumeration Date | 12/12/2005
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Last Update Date | 03/12/2009
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Provider Practice Location Address
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Address Line | 3201 W PEORIA AVE SUITE B404
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City | PHOENIX
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State | AZ
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Zip | 85029-4608
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Country | US
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Telephone | 602-336-8600
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Fax | 602-942-8716
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Provider Business Mailing Address
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Address Line | PO BOX 52527
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City | PHOENIX
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State | AZ
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Zip | 85072-2527
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Country | US
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Telephone | 480-545-0113
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Fax | 480-545-4267
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | MR. DANIEL J SCHAEFER
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Credential |
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Telephone | 770-300-0101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State | AZ
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