Provider Demographics
NPI:1699390211
Name:EW BREAST IMAGING LLC
Entity Type:Organization
Organization Name:EW BREAST IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ESZTER
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-314-7600
Mailing Address - Street 1:8896 E BECKER LN STE 101
Mailing Address - Street 2:
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:480-767-7601
Practice Address - Street 1:8896 E BECKER LN STE 101
Practice Address - Street 2:
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:480-767-7601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ45762OtherMEDICAL LICENSE