MEDICARE: MODERN DIAGNOSTIC IMAGING PC

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	261QR0200X	Radiology Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0153760	OTHER	AZ	BCBSAZ
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2Z2341	OTHER	AZ	HEALTH NET OF ARIZONA

General Provider Information

NPI Number	:	1518932110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODERN DIAGNOSTIC IMAGING PC

Provider Business Mailing Address
First Line	:	600 S DOBSON RD
Second Line	:	B16
City	:	CHANDLER
State	:	AZ
Zip	:	85224-5678
Country	:	US
Telephone Number	:	480-445-9961
Fax Number	:	480-445-9972

Provider Business Practice Location Address
First Line	:	600 S DOBSON RD
Second Line	:	B16
City	:	CHANDLER
State	:	AZ
Zip	:	85224-5678
Country	:	US
Telephone Number	:	480-445-9961
Fax Number	:	480-445-9972

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SHEETAL G. MEHTA
Credential	:
Telephone Number	:	480-445-9961

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	03/12/2012

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Directions to “MODERN DIAGNOSTIC IMAGING PC ” Practice Location

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