Organization
P.E.T. SCAN ARIZONA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRY A. BROWN MHA (EXECUTIVE DIRECTOR)
(602) 589-7226
Entity
Organization
Contact information
Practice address
6036 N 19TH AVE, SUITE 305, PHOENIX, AZ 85015-2106
(602) 589-7226
(602) 589-0816
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
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083616569
NPI
—
01
—
1Z7140
HEALTH NET
AZ
05
—
555386
—
AZ
01
—
AZ0891570
BCBS AZ
AZ
Enumeration date
08/15/2005
Last updated
07/21/2022
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