Basic Information
| Provider Information | |||||||||
| NPI: | 1982663688 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARIZONA RADIOLOGY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 27340 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850617340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029439200 | ||||||||
| FaxNumber: | 6022163000 | ||||||||
| Practice Location | |||||||||
| Address1: | 4700 N 51ST AVE | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850311237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238493800 | ||||||||
| FaxNumber: | 6238466060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2006 | ||||||||
| LastUpdateDate: | 03/29/2010 | ||||||||
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| AuthorizedOfficialLastName: | HOFFMAN | ||||||||
| AuthorizedOfficialFirstName: | MARLEE | ||||||||
| AuthorizedOfficialMiddleName: | RAVENSCROFT | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6029771177 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
ID Information
| ID | Type | State | Issuer | Description | 910118 | 05 | AZ | MEDICAID | 2Z1493 | 01 | AZ | HEALTH NET | OTHER | AZ0209410 | 01 | AZ | BCBSAZ | OTHER |