Arizona Coast Wide Open MRI, PLLC

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

Legal business name

ARIZONA COAST WIDE OPEN MRI, PLLC

Practice address

2130 Mesquite Ave
Suite 108
Lake Havasu City, AZ 86403-6897

Phone

(602) 943-9200

NPI assigned

Feb 28, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jack Dunn, M.D.NPI 1598750820

Title

Owner

Phone

(928) 669-7480

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jack D Dunn, M.D.

  • Diagnostic Radiology Physician
  • Lake Havasu City, AZ
  • NPI 1598750820
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1298851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553644800000",
    "number": "1003113010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 39",
            "city": "OVERGAARD",
            "state": "AZ",
            "postal_code": "859330039",
            "telephone_number": "928-535-6667",
            "fax_number": "928-535-5561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2130 MESQUITE AVE",
            "address_2": "SUITE 108",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864036897",
            "telephone_number": "602-943-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARIZONA COAST WIDE OPEN MRI, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-28",
        "last_updated": "2019-03-27",
        "status": "A",
        "authorized_official_last_name": "DUNN",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-669-7480",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "605261",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "Z146172",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Arizona CVS Stores
• Arizona CVS Stores LLC
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• Arizona Dental Sleep Therapy
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• Radiology Clinic/Center in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Radiology Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.