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General NPI Number Information
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NPI Number | 1104014257
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Entity Type | Organization
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Legal Business Name | SIERRA VISTA DIAGNOSTICS LLC
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Dates
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Enumeration Date | 10/12/2007
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Last Update Date | 12/19/2012
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Provider Practice Location Address
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Address Line | 155 CALLE PORTAL STE 500
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-2973
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Country | US
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Telephone | 520-459-5227
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Fax | 520-459-2191
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Provider Business Mailing Address
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Address Line | 155 CALLE PORTAL STE 500
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-2973
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Country | US
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Telephone | 520-459-5227
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Fax | 520-459-2191
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. STEVEN I. WALSH
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Credential | M.D.
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Telephone | 520-459-5227
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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 | 9110
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License Number State | AZ
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