Southeast X-Ray LLC
Clinic/Center, Radiology in Phoenix, AZ. Organization (NPI-2).
NPI number1154565802
StatusActive
Last updated in NPPESJul 17, 2026
Details
- NPI
- 1154565802
- Entity type
- Organization (NPI-2)
- Legal business name
- Southeast X-Ray LLC
- Organization subpart
- No
- Enumeration date
- Apr 24, 2009
- Certification date
- Jul 17, 2026
- Last updated
- Jul 17, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QR0200X | Clinic/Center, Radiology | – | – | Yes |
Practice location
22601 N 19th Ave Ste 108Phoenix, AZ 85027-1324
Phone 480-369-1270
Mailing address
22601 N 19th Ave Ste 108Phoenix, AZ 85027-1324
Authorized official
Robert Scott Thornock
Chief Strategy Officer
4803691270
Is something wrong?
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