Provider Demographics
NPI:1154971497
Name:SMSJ IMAGING COMPANY LLC
Entity type:Organization
Organization Name:SMSJ IMAGING COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:SKRNICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-779-3764
Mailing Address - Street 1:400 W CAMINO CASA VERDE STE 200
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-3569
Mailing Address - Country:US
Mailing Address - Phone:206-489-4805
Mailing Address - Fax:
Practice Address - Street 1:400 W CAMINO CASA VERDE STE 200
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-3569
Practice Address - Country:US
Practice Address - Phone:520-648-9480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty