Organization Active NPI

MRI of Arizona Inc

  • Clinical Medical Laboratory
  • Phoenix, AZ
National Provider Identifier
1063403616
Registry record updated Aug 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
OTC 3586 Issued in AZ
Legal business name
MRI OF ARIZONA INC
Doing business as
MRI OF ARIZONA
Practice address
701 W Glendale Ave
Phoenix, AZ 85021-8629
Phone
(602) 294-9009
Fax
(602) 294-9012
NPI assigned
Nov 2, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2013

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

Authorized official

Name
Mr. Steve Borta
Title
President
Phone
(602) 294-9009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X OTC 3586 AZ Primary

Addresses

Primary practice location

701 W Glendale Ave
Phoenix, AZ 85021-8629

Mailing address

701 W Glendale Ave
Phoenix, AZ 85021-8629
Phone (602) 294-9009

Other identifiers 1

IdentifierTypeStateIssuer
115320001MedicaidAZ

Other names 1

  • MRI OF ARIZONA Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071126000265 AZ Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 4082690110 Practice locations: Phoenix, AZ

National Provider Directory

National Provider Directory

Locations

701 W Glendale Ave
Phoenix, AZ 85021
Phone (602) 294-9009

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": "1130889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377648000000",
    "number": "1063403616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 W GLENDALE AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850218629",
            "telephone_number": "602-294-9009",
            "fax_number": "602-294-9012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 W GLENDALE AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850218629",
            "telephone_number": "602-294-9009",
            "fax_number": "602-294-9012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MRI OF ARIZONA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-02",
        "last_updated": "2013-08-28",
        "status": "A",
        "authorized_official_last_name": "BORTA",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "602-294-9009",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "AZ",
            "license": "OTC 3586",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "115320001",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MRI OF ARIZONA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2013; 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.