Provider Demographics
NPI:1639205909
Name:ARIZONA BREASTNET, LLC
Entity Type:Organization
Organization Name:ARIZONA BREASTNET, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:TIGGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-926-1696
Mailing Address - Street 1:8896 E BECKER LN
Mailing Address - Street 2:101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6281
Mailing Address - Country:US
Mailing Address - Phone:480-314-7600
Mailing Address - Fax:
Practice Address - Street 1:8896 E BECKER LN
Practice Address - Street 2:101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6281
Practice Address - Country:US
Practice Address - Phone:480-314-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ113462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDN4251OtherMEIDCARE RAIL ROAD
AZDN4251OtherMEIDCARE RAIL ROAD