ARIZONA COAST RADIOLOGY, PLLC (NPI# 1104064997) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104064997 |
| Entity Type | Organization |
| Organization Name | ARIZONA COAST RADIOLOGY, PLLC |
| Practice Address |
101 Civic Center Ln Lake Havasu City AZ 86403-5607 |
| Mailing Address |
2610 Patio Simpatico Lake Havasu City AZ 86406-7789 |
| Practice Telephone | 9284127485 |
| Mailing Telephone | 9284127485 |
| Enumeration Date | 2009-02-02 |
| Last Update Date | 2009-02-02 |
| Authorized Official Name | JACK D DUNN (MEMBER) |
| Authorized Official Telephone | 9284127485 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| Street Address |
101 CIVIC CENTER LN |
| City | LAKE HAVASU CITY |
| State | AZ |
| Zip Code | 86403-5607 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639176233 | Pamela B. Reband | Anesthesiology | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2005-06-28 |
| 1659995652 | Alana Stern | Physician Assistant | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2020-06-04 |
| 1245702927 | Michael Barber | Registered Nurse | 101 Civic Center Ln, Lake Havasu City, AZ 86403 | 2018-12-19 |
| 1891276630 | Brian Andrew | Physician Assistant | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2018-08-28 |
| 1497264873 | Pinnacle Radiology Services | Radiology | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2017-09-28 |
| 1821516287 | Jaime Wasik | Nurse Practitioner | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2017-09-06 |
| 1144776055 | Paul Queior | Physician Assistant | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2016-08-30 |
| 1891146957 | Misty Maple | Nurse Practitioner | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2016-06-29 |
| 1316319460 | Sarah Fraser | Specialist/Technologist, Other | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2015-10-28 |
| 1780067280 | Samer Asem Haddad | Internal Medicine | 101 Civic Center Ln, Lake Havasu City, AZ 86403 | 2015-07-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104479039 | Liska's Apothecary Shop, Inc. | Assisted Living Facility | 1840 Mesquite Ave., Ste. E, Lake Havasu City, AZ 86403 | 2019-07-19 |
| 1275033227 | Ayad Costy | Pharmacist | 75 North Lake Havasu City, Lake Havasu City, AZ 86403 | 2018-02-16 |
| 1942727250 | Ideal Health Care, L.L.C. | Prosthetic/Orthotic Supplier | 1675 Mesquite Ave Ste A, Lake Havasu City, AZ 86403 | 2017-08-28 |
| 1063965036 | Cerner Health Connections, Inc | Clinic/Center | 89 Civic Center Blvd, Lake Havasu City, AZ 86403 | 2016-07-26 |
| 1447643358 | Lundin Dental PC | Durable Medical Equipment & Medical Supplies | 1741 Mesquite Avenue Ste B 100, Lake Havasu City, AZ 86403 | 2015-03-17 |
| 1912301425 | Arizona Havasu Bdm Pak LLC | Dentist | 1799 North Kiowa Blvd, Unit 109, Lake Havasu, AZ 86403 | 2014-10-13 |
| 1386047850 | Emily E Vona | Nurse Practitioner | 84 Acoma Blvd N Ste 104, Lake Havasu City, AZ 86403 | 2014-09-29 |
| 1750700589 | Thomas Wennergren | Pharmacist | 25 S Lake Havasu Ave, Lake Havasu City, AZ 86403 | 2014-04-09 |
| 1285997460 | Jamie L Lemire | Pharmacist | 1980 Mcculloch Blvd, Lake Havasu City, AZ 86403 | 2012-06-21 |
| 1053694448 | Goodwill of Northern Arizona | Exclusive Provider Organization | 1990 Mcculloch Blvd North, Lake Havasu City, AZ 86403 | 2011-09-22 |
| Find all providers in zip 86403 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972825644 | Havasu Regional Medical Center LLC | Radiology | 1799 Kiowa Ave, # 104, Lake Havasu City, AZ 86403-2881 | 2010-02-23 |
| 1972657633 | Daniel Rawn Emig | Radiology | 3662 N Winifred Way, Lake Havasu City, AZ 86404-5959 | 2007-01-22 |
| 1528003233 | Radiological Services of Northern Arizona, PC | Radiology | 1944 Mesquite Ave, Lake Havasu City, AZ 86403-5729 | 2006-06-17 |
| 1598750820 | Jack D Dunn | Radiology | 2130 Mesquite Ave Unit 108, Lake Havasu City, AZ 86403-6897 | 2005-09-13 |
| 1497264873 | Pinnacle Radiology Services | Radiology | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2017-09-28 |
| 1316275290 | Peter M. Mamalakis | Radiology | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2009-12-03 |
| 1952592339 | Lake Havasu Radiology, Pllc | Radiology | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2007-08-09 |
| 1609808153 | Ayman Nicholas Awad | Radiology | 1944 Mesquite Ave, Lake Havasu City, AZ 86403-5729 | 2006-07-07 |
| 1669438867 | Open Mri of Lake Havasu LLC | Radiology | 2082 Mesquite Ave, Suite 114, Lake Havasu City, AZ 86403-6717 | 2006-04-25 |
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|---|---|---|---|---|
| 1295345783 | Susan Shotts | Radiology | 861 N Higley Rd Ste B101, Gilbert, AZ 85234-9602 | 2020-08-09 |
| 1841840188 | Smsj Imaging Company LLC | Radiology | 630 N Alvernon Way Ste 150, Tucson, AZ 85711-1844 | 2019-09-18 |
| 1417507765 | Smsj Imaging Company LLC | Radiology | 395 N Silverbell Rd Ste 185, Tucson, AZ 85745-2721 | 2019-09-18 |
| 1154971497 | Smsj Imaging Company LLC | Radiology | 400 W Camino Casa Verde Ste 200, Green Valley, AZ 85614-3569 | 2019-09-18 |
| 1740839786 | Smsj Imaging Company LLC | Radiology | 4892 N Stone Ave Ste 180, Tucson, AZ 85704-5761 | 2019-09-11 |
| 1689239824 | Thumb Butte Radiology, LLC | Radiology | 3120 Willow Creek Rd, Prescott, AZ 86301-6699 | 2019-05-02 |
| 1376017020 | Vpa PC | Radiology | 64 E Broadway Rd Ste 200231, Tempe, AZ 85282-1353 | 2019-01-16 |
| 1598243867 | Mdig of Florida, LLC | Radiology | 10835 N 25th Ave Ste 140, Phoenix, AZ 85029-3408 | 2018-07-30 |
| 1689182966 | Faca Vascular | Radiology | 1831 E Queen Creek Rd Ste 120, Chandler, AZ 85286-2019 | 2018-01-20 |
| 1265974836 | Teleradiology Specialists LLC | Radiology | 4813 E Piccadilly Rd, Phoenix, AZ 85018-5540 | 2016-11-13 |
| Find all providers with the same taxonomy | ||||
| City | LAKE HAVASU CITY |
| Zip Code | 86403 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.