Provider Demographics
NPI:1316206048
Name:ONE SOURCE RADIOLOGY
Entity Type:Organization
Organization Name:ONE SOURCE RADIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARREON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-399-1742
Mailing Address - Street 1:2076 E UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-4632
Mailing Address - Country:US
Mailing Address - Phone:480-656-5400
Mailing Address - Fax:480-656-5408
Practice Address - Street 1:2076 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-4632
Practice Address - Country:US
Practice Address - Phone:480-656-5400
Practice Address - Fax:480-656-5408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology