Provider Demographics
NPI:1841537842
Name:AZ-TECH RADIOLOGY & OPEN MRI, LLC
Entity type:Organization
Organization Name:AZ-TECH RADIOLOGY & OPEN MRI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAKESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PAHWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-889-3500
Mailing Address - Street 1:2653 W. GAUDALUPE RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-7200
Mailing Address - Country:US
Mailing Address - Phone:480-963-4183
Mailing Address - Fax:480-963-4184
Practice Address - Street 1:600 S. DOBSON RD SUITE
Practice Address - Street 2:SUITE E42
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-0000
Practice Address - Country:US
Practice Address - Phone:480-963-4183
Practice Address - Fax:480-963-4184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ872716Medicaid