Provider Demographics
NPI:1578515672
Name:ARIZONA WOMENS IMAGING
Entity Type:Organization
Organization Name:ARIZONA WOMENS IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUCKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-498-2095
Mailing Address - Street 1:4566 N 1ST AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5685
Mailing Address - Country:US
Mailing Address - Phone:520-498-2095
Mailing Address - Fax:520-498-2099
Practice Address - Street 1:4566 N 1ST AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-5685
Practice Address - Country:US
Practice Address - Phone:520-498-2095
Practice Address - Fax:520-498-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2158875174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ20210Medicare ID - Type Unspecified