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	:	1871199307
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	:	3618 W ANTHEM WAY STE D108
Second Line	:
City	:	ANTHEM
State	:	AZ
Zip	:	85086-0458
Country	:	US
Telephone Number	:	623-879-3740
Fax Number	:

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

Provider Enumeration Date	:	12/09/2020
Last Update Date	:	12/09/2020

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Practice Fax:

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