Organization
SMI IMAGING, LLC
Active
Other names
SimonMed Imaging - Fiesta
Organization subpart
No
Provider details
NPI number
Authorized official
HOWARD J SIMON M.D. (PRESIDENT)
(480) 264-2400
Entity
Organization
Contact information
Practice address
1457 W SOUTHERN AVE STE 26, MESA, AZ 85202-4862
(480) 306-6900
(480) 306-6910
Mailing address
PO BOX 7368, ORANGE, CA 92863-7368
(714) 571-5000
(714) 571-5055
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
OTC4689
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
472452
—
AZ
01
—
P00811052
RAILROAD MEDICARE
—
Enumeration date
09/03/2009
Last updated
05/07/2010
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