Organization
SCAN HEALTH IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANNTEJ SRA M.D (OWNER)
(623) 815-8200
Entity
Organization
Contact information
Practice address
13943 N 91ST AVE, SUITE 102, PEORIA, AZ 85381-3629
(623) 815-8200
(623) 344-5458
Mailing address
13943 N 91ST AVE, SUITE 102, PEORIA, AZ 85381-3629
(623) 815-8200
(623) 344-5458
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
28033
AZ
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1Z8710
HEALTHNET PIN
AZ
05
—
579394
—
AZ
Enumeration date
12/28/2010
Last updated
12/28/2010
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