Organization Name: | ARIZONA COAST WIDE OPEN MRI, PLLC |
NPI Number: | 1003113010 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JACK DUNN (OWNER) |
Mailing Address: | 2130 Mesquite Ave Suite 108 Lake Havasu City |
State: | AZ US |
Postal Code: | 864036897 |
Phone Number: | 6029439200 |
Fax Number: | |
NPI Enumeration Date: | 02/28/2011 |
NPI Last Update Date: | 10/02/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM1200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Magnetic Resonance Imaging (MRI) |
Taxonomy Definition: |