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Organization
PET SCAN ARIZONA LLC
Active
Organization
PET SCAN ARIZONA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRY A BROWN (EXECUTIVE DIRECTOR)
(623) 566-3777
Entity
Organization
Contact information
Practice address
13460 N 94TH DR, SUITE J-1, PEORIA, AZ 85381-4835
(623) 566-3777
(623) 566-1216
Mailing address
PO BOX 27340, PHOENIX, AZ 85061-7340
(602) 943-9200
(602) 216-3000
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1Z7140
HEALTH NET OF AZ
AZ
05
—
555386
—
AZ
01
—
AZ0891570
BCBSAZ
AZ
Enumeration date
02/22/2006
Last updated
12/05/2007
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