Provider Demographics
NPI:1982663688
Name:ARIZONA RADIOLOGY LLC
Entity Type:Organization
Organization Name:ARIZONA RADIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLEE
Authorized Official - Middle Name:RAVENSCROFT
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:602-977-1177
Mailing Address - Street 1:PO BOX 27340
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85061-7340
Mailing Address - Country:US
Mailing Address - Phone:602-943-9200
Mailing Address - Fax:602-216-3000
Practice Address - Street 1:4700 N 51ST AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1237
Practice Address - Country:US
Practice Address - Phone:623-849-3800
Practice Address - Fax:623-846-6060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ910118Medicaid
AZ2Z1493OtherHEALTH NET
AZAZ0209410OtherBCBSAZ
AZZ79691Medicare PIN
AZ910118Medicaid