Provider Demographics
NPI:1902896236
Name:SOUTHWEST DIAGNOSTIC IMAGING LTD
Entity Type:Organization
Organization Name:SOUTHWEST DIAGNOSTIC IMAGING LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AVP, PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASSIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-724-8477
Mailing Address - Street 1:PO BOX 207762
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7762
Mailing Address - Country:US
Mailing Address - Phone:480-558-5278
Mailing Address - Fax:
Practice Address - Street 1:3501 N SCOTTSDALE ROAD
Practice Address - Street 2:SUITE 130
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-8525
Practice Address - Country:US
Practice Address - Phone:480-425-5078
Practice Address - Fax:480-657-3470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Single Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ858178OtherAHCCCS
AZ858178OtherAHCCCS