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NPI Code Detail

MEDICARE: INTERVENTIONAL RADIOLOGY, LTD

MEDICARE: INTERVENTIONAL RADIOLOGY, LTD
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
12085R0202XDiagnostic Radiology Physician
22085R0204XVascular & Interventional Radiology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21Z7077OTHERAZHEALTH NET OF AZ

General Provider Information

NPI Number : 1356316954
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTERVENTIONAL RADIOLOGY, LTD
Provider Business Mailing Address
First Line : PO BOX 27340
Second Line :
City : PHOENIX
State : AZ
Zip : 85061-7340
Country : US
Telephone Number : 602-943-9200
Fax Number : 602-216-3000
Provider Business Practice Location Address
First Line : 1800 E VAN BUREN ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85006-3742
Country : US
Telephone Number : 602-254-2123
Fax Number : 602-254-4172
Authorized Official
Title or Position : PRESIDENT
Name : DR. CORDELL A ESPLIN
Credential : M.D.
Telephone Number : 602-254-2123
Provider Enumeration Date : 02/17/2006
Last Update Date : 12/05/2007

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