Provider Demographics
NPI:1417403304
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:MS
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:602-302-5706
Practice Address - Street 1:1313 W SAINT MARYS RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-3112
Practice Address - Country:US
Practice Address - Phone:520-449-8115
Practice Address - Fax:520-622-1185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPENDINGMedicare PIN