Provider Demographics
NPI:1558625046
Name:RPN OF ARIZONA
Entity Type:Organization
Organization Name:RPN OF ARIZONA
Other - Org Name:RADIOLOGY PROVIDER NETWORK OF ARIZONA, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-553-3315
Mailing Address - Street 1:PO BOX 3501
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-0951
Mailing Address - Country:US
Mailing Address - Phone:877-553-3315
Mailing Address - Fax:858-225-1855
Practice Address - Street 1:6102 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-1752
Practice Address - Country:US
Practice Address - Phone:877-553-3315
Practice Address - Fax:858-225-1855
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADIOLOGY PROVIDER NETWORK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-28
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)