Organization
CENTER FOR OUPATIENT IMAGING, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRANT NELSON (ADMINISTRATOR)
(480) 324-8033
Entity
Organization
Contact information
Practice address
1425 S GREENFIELD RD, SUITE 102, MESA, AZ 85206-5505
(480) 324-8033
(480) 324-8038
Mailing address
1425 S GREENFIELD RD, SUITE 102, MESA, AZ 85206-5505
(480) 324-8033
(480) 324-8038
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
—
AZ
261QR0206X
Mammography Clinic/Center
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0717920
BLUE CROSS ID
AZ
01
—
2Z0812
HEALTH NET
AZ
05
—
724874
—
AZ
Enumeration date
04/14/2006
Last updated
09/11/2025
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