NPIMap

Organization Active NPI

South County Diagnostic Services, LLC

  • Mammography Clinic/Center
  • San Luis, AZ
National Provider Identifier
1003481516
Registry record updated Jan 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mammography Clinic/CenterTaxonomy code 261QR0206X
Legal business name
SOUTH COUNTY DIAGNOSTIC SERVICES, LLC
Practice address
151 S Oak Ave Ste 5
San Luis, AZ 85336-0756
Phone
(928) 366-5184
Fax
(928) 722-6113
NPI assigned
May 26, 2021
Organization subpart
Yes
Parent organization
SOUTH COUNTY DIAGNOSTIC SERVICES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 5, 2024

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

Authorized official

Name
Amanda Aguirre
Title
President & Ceo
Phone
(928) 315-7910

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mammography Clinic/Center 261QR0206X Primary
Clinical Medical Laboratory 291U00000X

Addresses

Primary practice location

151 S Oak Ave Ste 5
San Luis, AZ 85336-0756

Mailing address

PO Box 617
Somerton, AZ 85350-0617
Phone (928) 315-7910

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210719000708 AZ Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 4981984606 Practice locations: San Luis, AZ

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
South County Diagnostic Services LLC3 organizations share this tax ID, including this one
Part of
South County Diagnostic Services LLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1621987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704412800000",
    "number": "1003481516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 617",
            "city": "SOMERTON",
            "state": "AZ",
            "postal_code": "853500617",
            "telephone_number": "928-315-7910",
            "fax_number": "928-627-1255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 S OAK AVE STE 5",
            "city": "SAN LUIS",
            "state": "AZ",
            "postal_code": "853360756",
            "telephone_number": "928-366-5184",
            "fax_number": "928-722-6113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH COUNTY DIAGNOSTIC SERVICES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTH COUNTY DIAGNOSTIC SERVICES, LLC",
        "enumeration_date": "2021-05-26",
        "last_updated": "2024-01-05",
        "certification_date": "2024-01-05",
        "status": "A",
        "authorized_official_last_name": "AGUIRRE",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "928-315-7910"
    },
    "taxonomies": [
        {
            "code": "261QR0206X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mammography",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2024; 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.