Provider Demographics
NPI:1992189864
Name:MRI OF ARIZONA INC
Entity Type:Organization
Organization Name:MRI OF ARIZONA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BORTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-294-9009
Mailing Address - Street 1:701 W GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-8629
Mailing Address - Country:US
Mailing Address - Phone:602-294-9009
Mailing Address - Fax:602-294-9012
Practice Address - Street 1:3139 E LINCOLN DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-2317
Practice Address - Country:US
Practice Address - Phone:602-294-9009
Practice Address - Fax:602-294-9012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC7025291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ175873Medicare PIN