MEDICARE: PHOENIX DIAGNOSTIC IMAGING INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician		AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00156014	OTHER	AZ	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1124003231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX DIAGNOSTIC IMAGING INC

Provider Business Mailing Address
First Line	:	PO BOX 7368
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92863-7368
Country	:	US
Telephone Number	:	714-571-5000
Fax Number	:	714-571-5055

Provider Business Practice Location Address
First Line	:	875 N GREENFIELD RD
Second Line	:	SUITE 107
City	:	GILBERT
State	:	AZ
Zip	:	85234-5044
Country	:	US
Telephone Number	:	480-813-8700
Fax Number	:	480-813-8707

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HOWARD J SIMON
Credential	:	M.D.
Telephone Number	:	480-264-2400

Provider Enumeration Date	:	12/12/2005
Last Update Date	:	08/27/2012

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Directions to “PHOENIX DIAGNOSTIC IMAGING INC ” Practice Location

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