Organization
PREMIER SPORTS IMAGING INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PERRY S HISCOK M.D. (OWNER)
(602) 943-9200
Entity
Organization
Contact information
Practice address
7111 W BELL RD, SUITE 104, GLENDALE, AZ 85308-8551
(623) 533-4465
Mailing address
PO BOX 27340, PHOENIX, AZ 85061-7340
(602) 943-9200
(602) 216-3000
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
27471
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2Z3264
HEALTH NET OF AZ
AZ
05
—
961905
—
AZ
01
—
AZ0782750
BCBSAZ
AZ
Enumeration date
04/17/2006
Last updated
01/06/2012
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