Organization
LAKE HAVASU IMAGING CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SYLVIA HEINER (OFFICE MANAGER)
(928) 505-9729
Entity
Organization
Contact information
Practice address
1944 MESQUITE AVE, LAKE HAVASU CITY, AZ 86403
(928) 505-9729
(928) 505-9200
Mailing address
1944 MESQUITE AVE, LAKE HAVASU CITY, AZ 86403-5729
(928) 505-9729
(928) 505-9200
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
470000882
RAIL ROAD MEDICARE
AZ
05
—
583729
—
AZ
Enumeration date
07/07/2006
Last updated
12/10/2019
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