Pueblo Radiology LLC

Primary specialty

Magnetic Resonance Imaging (MRI) Clinic/CenterTaxonomy code 261QM1200X

Legal business name

PUEBLO RADIOLOGY LLC

Practice address

1313 W Saint Marys Rd
Tucson, AZ 85745-3112

Phone

(520) 352-7600

Fax

(520) 352-7610

NPI assigned

Oct 22, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Daniel Alan Derhaag

Title

Manager

Phone

(520) 352-7600

Specialties & licenses 2

Addresses

Tax ID family

Canyon Medical Imaging2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Pueblo Radiology, LLC

  • Radiology Clinic/Center
  • Phoenix, AZ
  • NPI 1699091934
  NPD tax ID

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

{
    "created_epoch": "1256169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256169600000",
    "number": "1295061422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1810",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852521810",
            "telephone_number": "520-352-7600",
            "fax_number": "520-352-7610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1313 W SAINT MARYS RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857453112",
            "telephone_number": "520-352-7600",
            "fax_number": "520-352-7610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUEBLO RADIOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-22",
        "last_updated": "2009-10-22",
        "status": "A",
        "authorized_official_last_name": "DERHAAG",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "520-352-7600",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Albert Puckett, PT, MPT
• Shelia Jane Puckett, M.S. CCC-SLP
• Dorota E Pucyk, M.D.
• Pueblo Dental Management, Inc
• Pueblo Medical Clinic
• Puente Nuevo #2, LLC, Dba la Paloma Surgery Center
• Charles R Puett, RT(R)(CT)
• Arunbalaji Pugazhendhi, MBBS
• Sangeethabalasri Pugazhendhi, MD
• Thiripurasundari Pugazhendhi, M.D.

• Magnetic Resonance Imaging (MRI) Clinic/Center in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Magnetic Resonance Imaging (MRI) Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2009; 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.