PRESCOTT INTERVENTIONAL RADIOLOGY LLC (NPI# 1457314825) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457314825 |
| Entity Type | Organization |
| Organization Name | PRESCOTT INTERVENTIONAL RADIOLOGY LLC |
| Practice Address |
980 Willow Creek Rd Prescott AZ 86301-1611 |
| Mailing Address |
Po Box 27340 Phoenix AZ 85061-7340 |
| Practice Telephone | 9284430077 |
| Practice Fax Number | 9284430019 |
| Mailing Telephone | 6029439200 |
| Mailing Fax Number | 6022163000 |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. MOHAMED A KIRDANI (PRESIDENT OWNER) |
| Authorized Official Telephone | 9284430077 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians | ||
| X | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| HEALTH NET | 1Z7128 | 01 |
| Street Address |
980 WILLOW CREEK RD |
| City | PRESCOTT |
| State | AZ |
| Zip Code | 86301-1611 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760457741 | Sean P Henrie | Dentist | 980 Willow Creek Rd, Suite 103, Prescott, AZ 86301-1611 | 2006-02-22 |
| 1184032328 | Kristin Steele | Dentist | 980 Willow Creek Rd, Suite 103, Prescott, AZ 86301-1611 | 2014-07-31 |
| 1043547870 | Sonora Quest Laboratories, LLC | Clinical Medical Laboratory | 980 Willow Creek Rd, Ste 203, Prescott, AZ 86301-1611 | 2009-11-16 |
| 1669647137 | Stephen A. Cantor, M.d., P.C. | Internal Medicine | 980 Willow Creek Rd, Suite 201, Prescott, AZ 86301-1611 | 2008-04-25 |
| 1376715458 | Advanced Cardiac Specialists, Chartered | Nuclear Medicine | 980 Willow Creek Rd, Suite 201, Prescott, AZ 86301-1611 | 2008-03-28 |
| 1265641203 | Jonathan Robert Bundy | Optometrist | 980 Willow Creek Rd, Suite 202, Prescott, AZ 86301 | 2007-05-22 |
| 1639132095 | Mohamed A Kirdani | Radiology | 980 Willow Creek Rd, Prescott, AZ 86301-1611 | 2006-04-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871102350 | Dove Marie Gundermann | Specialist/Technologist | 300 W. Gurley St, Prescott, AZ 86301 | 2020-07-30 |
| 1639712110 | Arizona Orthopedic Physical Therapy, Pllc | Clinic/Center | 1781 E State Highway 69, Suite 28, Prescott, AZ 86301 | 2019-10-28 |
| 1538714092 | Prescott Complete Care | Family Medicine | 1947 Commerce Center Circle, Suite A, Prescott, AZ 86301 | 2019-08-01 |
| 1336612571 | Sarah Elizabeth Elliott | Registered Nurse | 500 Az 89, Prescott, AZ 86301 | 2019-01-10 |
| 1912484270 | Asya Ruth Perkins | Counselor | 225 Grove Avenue, Prescott, AZ 86301 | 2018-07-19 |
| 1396241394 | Jerome Alexander Longoria | Chiropractor | 142 N. Rush St, Prescott, AZ 86301 | 2018-03-30 |
| 1619487675 | Yavapai Healthcare Group LLC | Nurse Practitioner | 999 Division Street, Prescott, AZ 86301 | 2017-10-04 |
| 1053835843 | United States Veterans Initiative | Counselor | 917 E Gurley St, Prescott, AZ 86301 | 2017-08-02 |
| 1164896999 | Spitler - Lilley, LLC | Hearing Instrument Specialist | 1781 E. State Rte 69, Suite 65, Prescott, AZ 86301 | 2015-11-17 |
| 1275925265 | Oral and Facial Surgery Center of Prescott | Dentist | 5415 Distiction Way, Prescott, AZ 86301 | 2015-02-27 |
| Find all providers in zip 86301 | ||||
| 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 |
|---|---|---|---|---|
| 1689239824 | Thumb Butte Radiology, LLC | Radiology | 3120 Willow Creek Rd, Prescott, AZ 86301-6699 | 2019-05-02 |
| 1588961585 | Bruce Medford Burtan | Radiology | 2097 Summer Breeze Dr, Prescott, AZ 86303-7412 | 2011-02-28 |
| 1679511356 | Karen Stark Caldemeyer | Radiology | 9925 N Clear Fork Rd, Prescott, AZ 86305-9016 | 2006-06-03 |
| 1932171618 | David K Lloyd | Radiology | 1000 Ainsworth Dr Ste 115, Prescott, AZ 86305-1667 | 2006-02-06 |
| 1225019425 | Timothy D Olthoff | Radiology | 810 Whipple St, Prescott, AZ 86301-1606 | 2005-11-07 |
| 1669476123 | Karl Theodore Wickstrom | Radiology | 790 Gail Gardner Way, Prescott, AZ 86305-2337 | 2005-06-10 |
| 1609960707 | Mary M Poncel | Radiology | 500 N Hwy 89, Northern Arizona Va Hcs, Prescott, AZ 86313 | 2006-10-03 |
| 1235236589 | Bernard Sakowicz | Radiology | 500 N Hwy 89, Northern Arizona Va Hcs, Prescott, AZ 86313 | 2006-09-20 |
| 1962418863 | Richard Wallace Vanbuskirk Sr. | Radiology | 500 N Us Highway 89, Prescott, AZ 86313-5001 | 2006-07-31 |
| 1427006253 | Medwise PC | Radiology | 790 Gail Gardner Way, Prescott, AZ 86305-2337 | 2006-05-04 |
| Find all providers in PRESCOTT | ||||
Please comment or provide details below to improve the information on PRESCOTT INTERVENTIONAL RADIOLOGY LLC.
| 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.