Provider Demographics
NPI:1225422736
Name:THE CENTER FOR MUSCULOSKELETAL ULTRASOUND OF ARIZONA
Entity Type:Organization
Organization Name:THE CENTER FOR MUSCULOSKELETAL ULTRASOUND OF ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:JABLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-239-3968
Mailing Address - Street 1:910 S EL CAMINO REAL STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4279
Mailing Address - Country:US
Mailing Address - Phone:949-219-1943
Mailing Address - Fax:949-218-1946
Practice Address - Street 1:9821 N 95TH ST STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4589
Practice Address - Country:US
Practice Address - Phone:480-239-5539
Practice Address - Fax:949-218-1946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE11OtherDIAGNOSTIC IMAGING