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

Laboratory Demographics

  • CLIA Code: 03D1078570
  • Facility Name: SMI IMAGING LLC DBA SIMONMED IMAGING - FOUNTAINS
  • Facility Address: 5620 W THUNDERBIRD RD SUITE A
    GLENDALE, AZ
    ZIP 85306
  • Facility Phone: 602 954-0954
  • Facility Type: Other - DIAGNOSTIC IMAGING
  • Facility Type: Waiver
  • Lab Director: HOWARD J. SIMON
  • NPI Number: 1932705878
  • Taxonomy: 2085R0202X - Radiology

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/11/2024
Certificate Expiration Date 4/10/2026
Facility Type Other - DIAGNOSTIC IMAGING
Lab Director HOWARD J. SIMON

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This page was last updated on: 9/29/2025