Provider Demographics
NPI:1972004489
Name:SMI IMAGING, LLC
Entity Type:Organization
Organization Name:SMI IMAGING, LLC
Other - Org Name:SIMONMED IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-478-6545
Mailing Address - Street 1:16220 N SCOTTSDALE RD STE 600
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1804
Mailing Address - Country:US
Mailing Address - Phone:480-306-6949
Mailing Address - Fax:602-302-5706
Practice Address - Street 1:6740 E CAMELBACK RD STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-2096
Practice Address - Country:US
Practice Address - Phone:602-651-1945
Practice Address - Fax:602-302-5706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
No261QR0207XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile MammographyGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty