NPIMap

Organization Active NPI

South County Diagnostic Services, LLC

  • Diagnostic Radiology Physician
  • San Luis, AZ
National Provider Identifier
1871040436
Registry record updated Jun 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
SOUTH COUNTY DIAGNOSTIC SERVICES, LLC
Practice address
1233 N Main St Ste 1B
San Luis, AZ 85336-0663
Phone
(928) 550-5103
Fax
(928) 550-5093
NPI assigned
Sep 1, 2016
Last updated
Jun 29, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2026

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

Authorized official

Name
Marisol Penuelas
Title
Clinical Operations Director
Phone
(928) 315-7910

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X NU Primary

Addresses

Primary practice location

1233 N Main St Ste 1B
San Luis, AZ 85336-0663

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
O20161214001750 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

Other organizations with this tax ID 2

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

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782691200000",
    "number": "1871040436",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1233 N MAIN ST STE 1B",
            "city": "SAN LUIS",
            "state": "AZ",
            "postal_code": "853360663",
            "telephone_number": "928-550-5103",
            "fax_number": "928-550-5093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH COUNTY DIAGNOSTIC SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-01",
        "last_updated": "2026-06-29",
        "certification_date": "2026-06-29",
        "status": "A",
        "authorized_official_last_name": "PENUELAS",
        "authorized_official_first_name": "MARISOL",
        "authorized_official_title_or_position": "CLINICAL OPERATIONS DIRECTOR",
        "authorized_official_telephone_number": "928-315-7910"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "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 Jun 29, 2026; 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.