Provider Demographics
NPI:1861477978
Name:PHOENIX DIAGNOSTIC IMAGING INC
Entity Type:Organization
Organization Name:PHOENIX DIAGNOSTIC IMAGING INC
Other - Org Name:PHOENIX DIAGNOSTIC IMAGING SCOTTSDALE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-300-0101
Mailing Address - Street 1:PO BOX 52527
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85072-2527
Mailing Address - Country:US
Mailing Address - Phone:480-545-0113
Mailing Address - Fax:480-545-4267
Practice Address - Street 1:8952 E DESERT COVE DR
Practice Address - Street 2:SUITE 113
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6775
Practice Address - Country:US
Practice Address - Phone:480-314-7772
Practice Address - Fax:480-314-7719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ79713Medicare ID - Type UnspecifiedIDTF