P.E.T. Scan Arizona LLC

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

Legal business name

P.E.T. SCAN ARIZONA LLC

Practice address

6036 N 19TH Ave
Suite 305
Phoenix, AZ 85015-2106

Phone

(602) 589-7226

Fax

(602) 589-0816

NPI assigned

Aug 15, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Terry A. Brown, MHA

Title

Executive Director

Phone

(602) 589-7226

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

Practitioners 1

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

• Traci Pritchard, M.D.

  • Diagnostic Radiology Physician
  • Phoenix, AZ
  • NPI 1326006586
  NPD (past)

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

{
    "created_epoch": "1124064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1083616569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27340",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850617340",
            "telephone_number": "602-943-9200",
            "fax_number": "602-216-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6036 N 19TH AVE",
            "address_2": "SUITE 305",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850152106",
            "telephone_number": "602-589-7226",
            "fax_number": "602-589-0816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "P.E.T. SCAN ARIZONA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-15",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "602-589-7226",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MHA"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1083616569",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "555386",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS AZ",
            "identifier": "AZ0891570",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "1Z7140",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Radiology Clinic/Center in Phoenix, AZ
• Providers in Phoenix, 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 Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.