03D2092179 CLIA NUMBER - SMI IMAGING, LLC DBA SIMONMED IMAGING - CENTRAL PHOENIX II

Laboratory Demographics

  • CLIA Code: 03D2092179
  • Facility Name: SMI IMAGING, LLC DBA SIMONMED IMAGING - CENTRAL PHOENIX II
  • Facility Address: 2620 N 3RD STREET STE 101
    PHOENIX, AZ
    ZIP 85004
  • Facility Phone: 602 234-2994
  • Facility Type: Other - O/PATIENT MEDICAL IMAGING
  • Facility Type: Waiver
  • Lab Director: BRIAN ALLEN HOLTAN
  • NPI Number: 1982149977
  • Taxonomy: 261QR0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D2092179
LAB Type Other - O/PATIENT MEDICAL IMAGING
Facility Name SMI IMAGING, LLC DBA SIMONMED IMAGING - CENTRAL PHOENIX II
Street 2620 N 3RD STREET STE 101
City PHOENIX
State AZ
ZIP 85004
Phone 602 234-2994
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/27/2025
Certificate Expiration Date 2/26/2027
Facility Type Other - O/PATIENT MEDICAL IMAGING
Lab Director BRIAN ALLEN HOLTAN

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