Provider Demographics
NPI:1124078431
Name:ARIZONA ADVANCED IMAGING CENTER LLC
Entity type:Organization
Organization Name:ARIZONA ADVANCED IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAHNISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-308-7718
Mailing Address - Street 1:4566 E INVERNESS AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4633
Mailing Address - Country:US
Mailing Address - Phone:480-308-7718
Mailing Address - Fax:480-308-7717
Practice Address - Street 1:4566 E INVERNESS AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4633
Practice Address - Country:US
Practice Address - Phone:480-380-7718
Practice Address - Fax:480-308-7717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC3591261QR0200X, 261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ858532Medicaid
AZDC2759OtherRAILROAD MEDICARE
AZ858532Medicaid
AZZ159798Medicare PIN
AZZ106774Medicare PIN