Provider Demographics
NPI:1700325511
Name:SMI IMAGING, LLC
Entity Type:Organization
Organization Name:SMI IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIANS ONBOARDING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:
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:
Practice Address - Street 1:10440 E RIGGS RD
Practice Address - Street 2:120 & 110
Practice Address - City:SUN LAKES
Practice Address - State:AZ
Practice Address - Zip Code:85248-7751
Practice Address - Country:US
Practice Address - Phone:480-883-6860
Practice Address - Fax:602-302-5862
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIMONMED IMAGING, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03D2114227261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology