Basic Information
Provider Information
NPI: 1740839786
EntityType: 2
ReplacementNPI:  
OrganizationName: SMSJ IMAGING COMPANY LLC
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Mailing Information
Address1: 4892 N STONE AVE STE 180
Address2:  
City: TUCSON
State: AZ
PostalCode: 857045761
CountryCode: US
TelephoneNumber: 5208725300
FaxNumber:  
Practice Location
Address1: 4892 N STONE AVE STE 180
Address2:  
City: TUCSON
State: AZ
PostalCode: 857045761
CountryCode: US
TelephoneNumber: 5208725300
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/11/2019
LastUpdateDate: 12/11/2020
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: SKRNICH
AuthorizedOfficialFirstName: DALE
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AuthorizedOfficialTitleorPosition: AUTHORIZED OFFICIAL
AuthorizedOfficialTelephone: 4697793764
IsSoleProprietor:  
IsOrganizationSubpart: N
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NPICertificationDate: 12/11/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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