NPIMap

Organization Active NPI

Desert Valley Radiology, PLC

Doing business as Desert Valley Radiology

  • Radiology Clinic/Center
  • Mesa, AZ
National Provider Identifier
1649368515
Registry record updated Mar 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
DESERT VALLEY RADIOLOGY, PLC
Doing business as
Desert Valley Radiology
Practice address
5424 E. Southern Ave.
Ste. 101
Mesa, AZ 85206-3621
Phone
(480) 776-5340
Fax
(480) 776-5344
NPI assigned
Oct 10, 2006
Last updated
Mar 8, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2011

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

Authorized official

Name
William J Wall III, M.D.
Title
President
Phone
(602) 867-0404

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

5424 E. Southern Ave.
Ste. 101
Mesa, AZ 85206-3621

Mailing address

4045 E. Bell Rd.
Ste. 143
Phoenix, AZ 85032-2245
Phone (602) 867-0404

Other identifiers 1

IdentifierTypeStateIssuer
333218MedicaidAZ

Other names 1

  • Desert Valley Radiology Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Desert Valley Radiology4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

16620 N 40th St
Ste D4
Phoenix, AZ 85032
Phone (602) 788-2253

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299542400000",
    "number": "1649368515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4045 E. BELL RD.",
            "address_2": "STE. 143",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850322245",
            "telephone_number": "602-867-0404",
            "fax_number": "602-788-0893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5424 E. SOUTHERN AVE.",
            "address_2": "STE. 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852063621",
            "telephone_number": "480-776-5340",
            "fax_number": "480-776-5344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESERT VALLEY RADIOLOGY, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2011-03-08",
        "status": "A",
        "authorized_official_last_name": "WALL III",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "602-867-0404",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "333218",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Desert Valley Radiology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2011; 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.