Provider Demographics
NPI:1528003233
Name:RADIOLOGICAL SERVICES OF NORTHERN ARIZONA, PC
Entity Type:Organization
Organization Name:RADIOLOGICAL SERVICES OF NORTHERN ARIZONA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AYMAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:AWAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-505-9729
Mailing Address - Street 1:1944 MESQUITE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5729
Mailing Address - Country:US
Mailing Address - Phone:928-505-9729
Mailing Address - Fax:928-505-9200
Practice Address - Street 1:1944 MESQUITE AVE
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5729
Practice Address - Country:US
Practice Address - Phone:928-505-9729
Practice Address - Fax:928-505-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWCLCNMedicare PIN