Provider Demographics
NPI:1073716791
Name:GILA COUNTY RADIOLOGY PLLC
Entity Type:Organization
Organization Name:GILA COUNTY RADIOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DHRUVE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOPRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-757-1000
Mailing Address - Street 1:9522 E SAN SALVADORE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5569
Mailing Address - Country:US
Mailing Address - Phone:480-767-2111
Mailing Address - Fax:480-614-1420
Practice Address - Street 1:5880 S HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-9447
Practice Address - Country:US
Practice Address - Phone:480-767-2111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ245319Medicaid
AZ117649OtherMEDICARE