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General NPI Number Information
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NPI Number | 1649643602
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Entity Type | Organization
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Legal Business Name | ELITE VIEW IMAGING LLC
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Dates
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Enumeration Date | 11/12/2015
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Last Update Date | 11/12/2015
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Provider Practice Location Address
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Address Line | 1110 E MISSOURI AVE SUITE 140
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City | PHOENIX
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State | AZ
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Zip | 85014-2707
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Country | US
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Telephone | 602-274-4674
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Fax | 602-274-6060
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Provider Business Mailing Address
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Address Line | PO BOX 857
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City | COPPELL
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State | TX
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Zip | 75019-0857
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Country | US
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Telephone | 337-886-0883
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Fax | 337-886-1212
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STEPHEN SCOTT BROUSSARD
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Credential |
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Telephone | 337-349-4562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085D0003X
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Taxonomy Name | Diagnostic Neuroimaging (Radiology) Physician
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License Number | OTC5077
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License Number State | AZ
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