Provider Demographics
NPI:1043279128
Name:ADVANCED PHOENIX IMAGING PA
Entity Type:Organization
Organization Name:ADVANCED PHOENIX IMAGING PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AHSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAFAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-246-2490
Mailing Address - Street 1:5501 NORTH 19TH AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015
Mailing Address - Country:US
Mailing Address - Phone:602-246-2490
Mailing Address - Fax:602-246-2492
Practice Address - Street 1:5501 NORTH 19TH AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015
Practice Address - Country:US
Practice Address - Phone:602-246-2490
Practice Address - Fax:602-246-2492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ22445205Medicaid
AZ84976Medicare ID - Type Unspecified