MEDICARE: ARISTA IMAGING, 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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

General Provider Information

NPI Number	:	1730726365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARISTA IMAGING, LLC

Provider Business Mailing Address
First Line	:	173 MAIN ST
Second Line	:
City	:	THOMASTON
State	:	ME
Zip	:	04861-3807
Country	:	US
Telephone Number	:	207-706-6810
Fax Number	:

Provider Business Practice Location Address
First Line	:	3139 E LINCOLN DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016
Country	:	US
Telephone Number	:	602-368-2758
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	JANA ADAMS
Credential	:
Telephone Number	:	480-276-7955

Provider Enumeration Date	:	12/02/2019
Last Update Date	:	12/02/2019

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