Provider Demographics
NPI:1134258866
Name:AZ MOBILE IMAGING LLC
Entity type:Organization
Organization Name:AZ MOBILE IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:COON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-243-8650
Mailing Address - Street 1:PO BOX 4198
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-2570
Mailing Address - Country:US
Mailing Address - Phone:928-634-0665
Mailing Address - Fax:
Practice Address - Street 1:10240 W. INDIAN SCHOOL RD
Practice Address - Street 2:STE 155
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-5906
Practice Address - Country:US
Practice Address - Phone:623-536-1129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ111732Medicare PIN