Provider Demographics
NPI:1992929012
Name:SAVAGE, JIM (RDMS)
Entity type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:SAVAGE
Suffix:
Gender:M
Credentials:RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1584
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85902-1584
Mailing Address - Country:US
Mailing Address - Phone:928-532-0535
Mailing Address - Fax:
Practice Address - Street 1:3051 S WHITE MOUNTAIN RD
Practice Address - Street 2:SUITE D
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7435
Practice Address - Country:US
Practice Address - Phone:928-242-4154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41660247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist