Provider Demographics
NPI:1245634724
Name:SIMONMED IMAGING, INC
Entity type:Organization
Organization Name:SIMONMED IMAGING, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
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:602-651-1945
Mailing Address - Street 1:6900 E CAMELBACK RD
Mailing Address - Street 2:SUITE #700
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-2431
Mailing Address - Country:US
Mailing Address - Phone:602-651-1945
Mailing Address - Fax:602-302-5706
Practice Address - Street 1:6320 W UNION HILLS DR
Practice Address - Street 2:BUILDING B, STE A120
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1096
Practice Address - Country:US
Practice Address - Phone:602-535-2820
Practice Address - Fax:602-302-5966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPENDINGMedicare PIN