MEDICARE: SMSJ IMAGING COMPANY 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	:	1417507765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMSJ IMAGING COMPANY LLC

Provider Business Mailing Address
First Line	:	395 N SILVERBELL RD STE 185
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-2721
Country	:	US
Telephone Number	:	520-872-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	395 N SILVERBELL RD STE 185
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-2721
Country	:	US
Telephone Number	:	520-872-7200
Fax Number	:	520-872-2999

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	DALE SKRNICH
Credential	:
Telephone Number	:	469-779-3764

Provider Enumeration Date	:	09/18/2019
Last Update Date	:	12/11/2020

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