Provider Demographics
NPI:1295886315
Name:ARIZONA SONOGRAPHY GROUP INC.
Entity type:Organization
Organization Name:ARIZONA SONOGRAPHY GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GREB
Authorized Official - Suffix:
Authorized Official - Credentials:RDCS
Authorized Official - Phone:602-628-3881
Mailing Address - Street 1:1850 E SHEENA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4532
Mailing Address - Country:US
Mailing Address - Phone:602-628-3881
Mailing Address - Fax:602-595-8642
Practice Address - Street 1:1850 E SHEENA DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-4532
Practice Address - Country:US
Practice Address - Phone:602-628-3881
Practice Address - Fax:602-595-8642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ79215Medicare ID - Type UnspecifiedMEDICARE ID#