MEDICARE: DESERT MOBILE IMAGING LLC

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

General Provider Information

NPI Number	:	1316588072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT MOBILE IMAGING LLC

Provider Business Mailing Address
First Line	:	8960 E NORA CIR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85207-1441
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8960 E NORA CIR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85207-1441
Country	:	US
Telephone Number	:	602-395-0718
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANTHONY COLLINS
Credential	:	CRNA
Telephone Number	:	602-395-0718

Provider Enumeration Date	:	10/03/2019
Last Update Date	:	10/03/2019

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