Provider Demographics
NPI:1083703938
Name:BREASTNET SCREENING LLC
Entity Type:Organization
Organization Name:BREASTNET SCREENING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:TIGGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-765-9279
Mailing Address - Street 1:4401 E JANICE WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-8511
Mailing Address - Country:US
Mailing Address - Phone:602-765-9279
Mailing Address - Fax:602-765-9513
Practice Address - Street 1:13090 N 94TH DR
Practice Address - Street 2:102
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4256
Practice Address - Country:US
Practice Address - Phone:623-815-8200
Practice Address - Fax:602-765-9513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ113462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========OtherTIN