MEDICARE: AZ TECH RADIOLOGY AND OPEN MRI 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	174400000X	Specialist

General Provider Information

NPI Number	:	1588061543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AZ TECH RADIOLOGY AND OPEN MRI LLC

Provider Business Mailing Address
First Line	:	2653 W GUADALUPE RD
Second Line	:	SUITE 201
City	:	MESA
State	:	AZ
Zip	:	85202-7200
Country	:	US
Telephone Number	:	480-889-3500
Fax Number	:	480-889-3502

Provider Business Practice Location Address
First Line	:	2561 S SAINT PAUL ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-6218
Country	:	US
Telephone Number	:	303-758-3282
Fax Number	:

Authorized Official
Title or Position	:	CHAIRMAN-CEO
Name	:	MR. RAKESH PAHWA
Credential	:
Telephone Number	:	480-706-1096

Provider Enumeration Date	:	11/19/2014
Last Update Date	:	11/19/2014

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