Provider Demographics
NPI:1558513655
Name:MAMMOGRAPHY PARTNERS LLC
Entity Type:Organization
Organization Name:MAMMOGRAPHY PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. PT. ACCT.
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KANEWSKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-398-4114
Mailing Address - Street 1:8401 JACK FINNEY BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-3017
Mailing Address - Country:US
Mailing Address - Phone:800-945-2455
Mailing Address - Fax:
Practice Address - Street 1:13065 W MCDOWELL RD
Practice Address - Street 2:#C105
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-6439
Practice Address - Country:US
Practice Address - Phone:602-866-0503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ392451Medicaid