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Organization
ARIZONA COAST WIDE OPEN MRI, PLLC
Active
Organization
ARIZONA COAST WIDE OPEN MRI, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK DUNN M.D. (OWNER)
(928) 669-7480
Entity
Organization
Contact information
Practice address
2130 MESQUITE AVE, SUITE 108, LAKE HAVASU CITY, AZ 86403-6897
(602) 943-9200
Mailing address
PO BOX 39, OVERGAARD, AZ 85933-0039
(928) 535-6667
(928) 535-5561
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
605261
—
AZ
01
—
Z146172
MEDICARE PTAN
AZ
Enumeration date
02/28/2011
Last updated
03/27/2019
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