Provider Demographics
NPI:1629114442
Name:MAMMOGRAPHY PARTNERS, LLC
Entity Type:Organization
Organization Name:MAMMOGRAPHY PARTNERS, LLC
Other - Org Name:MEDTECH MAMMOGRAPHY CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-785-2119
Mailing Address - Street 1:PO BOX 50458
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85076-0458
Mailing Address - Country:US
Mailing Address - Phone:480-785-2119
Mailing Address - Fax:480-705-0617
Practice Address - Street 1:301 E BETHANY HOME RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1263
Practice Address - Country:US
Practice Address - Phone:602-866-0503
Practice Address - Fax:602-866-0528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10-MM-71502085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ051227Medicaid
AZZ123821Medicare PIN