Basic Information
| Provider Information | |||||||||
| NPI: | 1336757699 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARIZONA DIAGNOSTIC RADIOLOGY GROUP, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1160 PITTSFORD VICTOR RD STE D | ||||||||
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| City: | PITTSFORD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145343825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852188019 | ||||||||
| FaxNumber: | 5852188099 | ||||||||
| Practice Location | |||||||||
| Address1: | 4915 E BASELINE RD | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852342965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803549200 | ||||||||
| FaxNumber: | 4803549201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2020 | ||||||||
| LastUpdateDate: | 03/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | HAMES | ||||||||
| AuthorizedOfficialFirstName: | NORMAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 3104452800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.