Provider Demographics
NPI:1396720405
Name:PHOENIX DIAGNOSTIC IMAGING, INC
Entity type:Organization
Organization Name:PHOENIX DIAGNOSTIC IMAGING, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-300-0101
Mailing Address - Street 1:PO BOX 52527
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85072-2527
Mailing Address - Country:US
Mailing Address - Phone:480-545-0113
Mailing Address - Fax:480-545-4267
Practice Address - Street 1:1916 W BETHANY HOME RD
Practice Address - Street 2:SUITE 110
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2458
Practice Address - Country:US
Practice Address - Phone:602-242-5858
Practice Address - Fax:602-242-4725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ67328Medicare ID - Type Unspecified