Provider Demographics
NPI:1245618545
Name:ARIZONA STATE RADIOLOGY, PC
Entity Type:Organization
Organization Name:ARIZONA STATE RADIOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RAJUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-722-8994
Mailing Address - Street 1:12112 RANCHO VISTOSO BLVD 150-221
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85755
Mailing Address - Country:US
Mailing Address - Phone:520-722-8994
Mailing Address - Fax:520-624-0117
Practice Address - Street 1:12112 RANCHO VISTOSO BLVD 150-221
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85755
Practice Address - Country:US
Practice Address - Phone:520-722-8994
Practice Address - Fax:520-624-0117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty