Basic Information
| Provider Information | |||||||||
| NPI: | 1093884090 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CARONDELET HEALTH NETWORK | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CARONDELET IMAGING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2202 N FORBES BLVD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857451412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208727700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 630 N ALVERNON WAY | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857111843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208733000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2006 | ||||||||
| LastUpdateDate: | 09/10/2013 | ||||||||
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| AuthorizedOfficialLastName: | STRAUSS | ||||||||
| AuthorizedOfficialFirstName: | ALAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5208727790 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0206X | H0011 | AZ | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology, Mammography |
No ID Information.