MEDICARE: SMI 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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1831795756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMI IMAGING LLC

Provider Business Mailing Address
First Line	:	6900 E CAMELBACK RD STE 700
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-2400
Country	:	US
Telephone Number	:	480-306-6949
Fax Number	:	602-302-5706

Provider Business Practice Location Address
First Line	:	1110 E MISSOURI AVE STE 410
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-2704
Country	:	US
Telephone Number	:	602-274-4674
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	HOWARD JOHN SIMON
Credential	:	MD
Telephone Number	:	480-478-6545

Provider Enumeration Date	:	12/07/2020
Last Update Date	:	12/07/2020

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