MEDICARE: AZ-TECH RADIOLOGY & 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	261QR0200X	Radiology Clinic/Center		AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841537842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AZ-TECH RADIOLOGY & OPEN MRI, LLC

Provider Business Mailing Address
First Line	:	2653 W. GAUDALUPE RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85202-7200
Country	:	US
Telephone Number	:	480-963-4183
Fax Number	:	480-963-4184

Provider Business Practice Location Address
First Line	:	600 S. DOBSON RD SUITE
Second Line	:	SUITE E42
City	:	CHANDLER
State	:	AZ
Zip	:	85224-0000
Country	:	US
Telephone Number	:	480-963-4183
Fax Number	:	480-963-4184

Authorized Official
Title or Position	:	CEO
Name	:	MR. RAKESH PAHWA
Credential	:
Telephone Number	:	480-889-3500

Provider Enumeration Date	:	01/10/2013
Last Update Date	:	12/29/2014

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