03D1078570 CLIA NUMBER - SMI IMAGING LLC DBA SIMONMED IMAGING - FOUNTAINS

Laboratory Demographics

CLIA Number: 03D1078570

Facility Name: SMI IMAGING LLC DBA SIMONMED IMAGING - FOUNTAINS

Facility Address:
5620 W THUNDERBIRD RD SUITE A
GLENDALE, AZ
ZIP 85306
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Facility Phone Number: 602 954-0954

Facility Type: Other - DIAGNOSTIC IMAGING

Certificate Type: Waiver

NPI Number: 1932705878

Taxonomy: 2085R0202X - Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

CLIA Record

Field Name	Field Value
CLIA Number	03D1078570
LAB Type	Other - DIAGNOSTIC IMAGING
Facility Name	SMI IMAGING LLC DBA SIMONMED IMAGING - FOUNTAINS
Street	5620 W THUNDERBIRD RD SUITE A
City	GLENDALE
State	AZ
ZIP	85306
Phone	602 954-0954
CertificateType	4
CertificateEffectiveDate	4/11/2024
CertificateExpirationDate	4/10/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024