Provider Demographics
NPI:1184925141
Name:SIMONMED IMAGING A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SIMONMED IMAGING A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-809-4829
Mailing Address - Street 1:PO BOX 51227
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-5527
Mailing Address - Country:US
Mailing Address - Phone:888-685-3909
Mailing Address - Fax:800-508-4751
Practice Address - Street 1:400 CHANNING AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2801
Practice Address - Country:US
Practice Address - Phone:650-323-1343
Practice Address - Fax:650-323-1352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-08
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ65588YOtherBLUE SHIELD
ZZZ67572YOtherBLUE SHIELD
ZZZ69174YOtherBLUE SHIELD
DR1583OtherRAILROAD MEDICARE
ZZZ69392YOtherBLUE SHIELD
CAZZZ65588YOtherBLUE SHIELD OF CA
ZZZ67347YOtherBLUE SHIELD
ZZZ67346YOtherBLUE SHIELD
ZZZ68489YOtherBLUE SHIELD
ZZZ66173YOtherBLUE SHIELD
ZZZ69391YOtherBLUE SHIELD
ZZZ67572YOtherBLUE SHIELD
ZZZ69174YOtherBLUE SHIELD
ZZZ65588YOtherBLUE SHIELD