MEDICARE: BEN-ORA, HANSEN, & VANESIAN IMAGING

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	261QR0206X	Mammography Clinic/Center

General Provider Information

NPI Number	:	1629345707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEN-ORA, HANSEN, & VANESIAN IMAGING

Provider Business Mailing Address
First Line	:	15601 DALLAS PKWY
Second Line	:	SUITE 500
City	:	ADDISON
State	:	TX
Zip	:	75001-3353
Country	:	US
Telephone Number	:	469-398-4100
Fax Number	:

Provider Business Practice Location Address
First Line	:	11220 N TATUM BLVD STE 105
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-1629
Country	:	US
Telephone Number	:	602-493-0204
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	NATALIE KEHM
Credential	:
Telephone Number	:	469-398-4100

Provider Enumeration Date	:	11/17/2011
Last Update Date	:	09/12/2012

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