Basic Information
| Provider Information | |||||||||
| NPI: | 1700182979 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH MOUNTAIN IMAGING SPECIALISTS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9907 | ||||||||
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| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850680907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6237803751 | ||||||||
| FaxNumber: | 6237803752 | ||||||||
| Practice Location | |||||||||
| Address1: | 18404 N TATUM BLVD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850321510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6237803751 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2011 | ||||||||
| LastUpdateDate: | 02/04/2011 | ||||||||
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| AuthorizedOfficialLastName: | ANSPACH | ||||||||
| AuthorizedOfficialFirstName: | NATHAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6237803751 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | FACHE | ||||||||
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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.