MEDICARE: RPN OF ARIZONA

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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center
2	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1558625046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RPN OF ARIZONA

Provider Business Mailing Address
First Line	:	PO BOX 3501
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91761-0951
Country	:	US
Telephone Number	:	877-553-3315
Fax Number	:	858-225-1855

Provider Business Practice Location Address
First Line	:	6102 N 16TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-1752
Country	:	US
Telephone Number	:	877-553-3315
Fax Number	:	858-225-1855

Authorized Official
Title or Position	:	VP OF OPERATIONS
Name	:	AMBER PARKS
Credential	:
Telephone Number	:	877-553-3315

Provider Enumeration Date	:	06/28/2012
Last Update Date	:	01/02/2013

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Directions to “RPN OF ARIZONA ” Practice Location

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