Provider Demographics
NPI:1689636243
Name:PRESCOTT RADIOLOGISTS LLP
Entity Type:Organization
Organization Name:PRESCOTT RADIOLOGISTS LLP
Other - Org Name:PRESCOTT IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-778-1971
Mailing Address - Street 1:PO BOX 678308
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:KS
Mailing Address - Zip Code:75267-8308
Mailing Address - Country:US
Mailing Address - Phone:928-445-2700
Mailing Address - Fax:800-656-0593
Practice Address - Street 1:1003 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1641
Practice Address - Country:US
Practice Address - Phone:928-778-1971
Practice Address - Fax:982-771-5733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ30WCFJJ1FMedicare PIN
AZZWCFJJMedicare UPIN
AZZWCFJJMedicare PIN