=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790974178
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WORLD CLASS IMAGING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2007
-----------------------------------------------------
Last Update Date | 10/22/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2400 S AVENUE A
-----------------------------------------------------
City | YUMA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85364-7127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-726-5757
-----------------------------------------------------
Fax | 928-726-5845
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2400 S AVENUE A
-----------------------------------------------------
City | YUMA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85364-7127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-726-5757
-----------------------------------------------------
Fax | 928-726-5845
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KHIDIR OSMAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 928-726-5757
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number | OTC 4048
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------