Provider Demographics
NPI:1417002874
Name:STANDUP MRI OF AMERICA III
Entity Type:Organization
Organization Name:STANDUP MRI OF AMERICA III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-537-5100
Mailing Address - Street 1:121 NE LOOP 820
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-7375
Mailing Address - Country:US
Mailing Address - Phone:817-537-5100
Mailing Address - Fax:817-537-5200
Practice Address - Street 1:1110 E MISSOURI AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2707
Practice Address - Country:US
Practice Address - Phone:602-274-4674
Practice Address - Fax:602-274-6060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ77245Medicare PIN