Provider Demographics
NPI:1841380532
Name:STAND-UP MRI OF ARIZONA, LLC
Entity Type:Organization
Organization Name:STAND-UP MRI OF ARIZONA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-815-8500
Mailing Address - Street 1:8581 W KELTON LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-4757
Mailing Address - Country:US
Mailing Address - Phone:623-815-8500
Mailing Address - Fax:623-815-7773
Practice Address - Street 1:8581 W KELTON LN
Practice Address - Street 2:SUITE 202
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-4757
Practice Address - Country:US
Practice Address - Phone:623-815-8500
Practice Address - Fax:623-815-7773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ875693Medicaid
AZ875693Medicaid