Provider Demographics
NPI:1447286737
Name:TRANSRAY OF ARIZONA, P.C.
Entity type:Organization
Organization Name:TRANSRAY OF ARIZONA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONSTANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-883-0475
Mailing Address - Street 1:PO BOX 848208
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8208
Mailing Address - Country:US
Mailing Address - Phone:505-768-7374
Mailing Address - Fax:505-768-7374
Practice Address - Street 1:930 N MESA DR
Practice Address - Street 2:#1056
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-4321
Practice Address - Country:US
Practice Address - Phone:505-883-0475
Practice Address - Fax:505-883-0475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ847832Medicaid
AZ79611Medicare ID - Type Unspecified