{"npi":"1003113010","type":"NPI-2","status":"active","name":{"display":"Arizona Coast Wide Open Mri, PLLC","other":[],"organization_name":"ARIZONA COAST WIDE OPEN MRI, PLLC","authorised_official":"Jack Dunn"},"specialty":{"primary_taxonomy":"261QR0200X","primary_taxonomy_description":"Radiology Clinic","slug":"radiology-clinic","schema_org_specialty":"Radiography","all":[{"code":"261QM1200X","description":"Magnetic Resonance Imaging (MRI) Clinic/Center","primary":false,"state":null,"license":null},{"code":"261QR0200X","description":"Radiology Clinic","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"2130 MESQUITE AVE","city":"LAKE HAVASU CITY","state":"AZ","postal_code":"864036897","country_code":"US","street_2":"SUITE 108","phone":"6029439200"},{"purpose":"MAILING","street_1":"PO BOX 39","city":"OVERGAARD","state":"AZ","postal_code":"859330039","country_code":"US","phone":"9285356667","fax":"9285355561"}],"license":null,"identifiers":[{"type_code":"05","label":"Medicaid","value":"605261","state":"AZ","issuer":null},{"type_code":"01","label":"Other","value":"Z146172","state":"AZ","issuer":"MEDICARE PTAN"}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20110712000085","type_code":"12-47","type_desc":"PART B SUPPLIER - INDEPENDENT DIAGNOSTIC TESTING FACILITY (IDTF)","state":"AZ","pac_id":"6800064197"}]},"enumeration_date":"2011-02-28","last_updated":"2019-03-27","_meta":{"source":"NPPES","snapshot_date":"2019-03-27","doc_url":"https://findmynpi.com/api"}}