Organization
PREMIER SPORTS IMAGING OF GLENDALE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PERRY HISCOK M.D. (OWNER)
(623) 533-4465
Entity
Organization
Contact information
Practice address
7111 W BELL RD STE 104, GLENDALE, AZ 85308-8552
(602) 943-9200
(602) 216-3000
Mailing address
PO BOX 27340, PHOENIX, AZ 85061-7340
(602) 943-9200
(602) 216-3000
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
AZ
Other
Enumeration date
12/09/2011
Last updated
12/09/2011
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