Provider Demographics
NPI:1689239824
Name:THUMB BUTTE RADIOLOGY, LLC
Entity Type:Organization
Organization Name:THUMB BUTTE RADIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AYAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AGHA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-543-0300
Mailing Address - Street 1:3120 WILLOW CREEK RD UNIT 100
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-6852
Mailing Address - Country:US
Mailing Address - Phone:480-750-8130
Mailing Address - Fax:480-590-2479
Practice Address - Street 1:3120 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-6699
Practice Address - Country:US
Practice Address - Phone:480-750-8130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-02
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty