Provider Demographics
NPI:1114995875
Name:MEDICAL IMAGERY NORTH LLC
Entity Type:Organization
Organization Name:MEDICAL IMAGERY NORTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-788-1900
Mailing Address - Street 1:21031 N CAVE CREEK RD
Mailing Address - Street 2:SUITE F4
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-5525
Mailing Address - Country:US
Mailing Address - Phone:602-788-1900
Mailing Address - Fax:602-788-1902
Practice Address - Street 1:21031 N CAVE CREEK RD
Practice Address - Street 2:SUITE F4
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-5525
Practice Address - Country:US
Practice Address - Phone:602-788-1900
Practice Address - Fax:602-788-1902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ146525OtherAHCCCS GROUP BILLER #
AZ2Z4780OtherHEALTH NET OF AZ