Provider Demographics
NPI:1417507765
Name:SMSJ IMAGING COMPANY LLC
Entity Type:Organization
Organization Name:SMSJ IMAGING COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:SKRNICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-779-3764
Mailing Address - Street 1:395 N SILVERBELL RD STE 185
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2721
Mailing Address - Country:US
Mailing Address - Phone:520-872-7200
Mailing Address - Fax:
Practice Address - Street 1:395 N SILVERBELL RD STE 185
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2721
Practice Address - Country:US
Practice Address - Phone:520-872-7200
Practice Address - Fax:520-872-2999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty