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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