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Derry Imaging fax number
(603) 537-3046
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Imaging Orders / Prior Authorization
Used for: Imaging orders and authorization communications (MRI/CT orders, prior authorization).
Fax destination details
- Department
- Imaging Orders / Prior Authorization
- Purpose
- Imaging orders and authorization communications (MRI/CT orders, prior authorization).
- Form
- Order Form — MRI/CT Order Form
- Address
- Overlook Medical Park, 6 Tsienneto Road, Suite LL100, Derry, NH 03038; Bedford location: 160 South River Road, Suite 2100, Bedford, NH 03110
- Voice phone
- (603) 537-1363
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
Fill in patient name, date of birth, exam type (MRI/MRA/CT/CTA), referring physician, insurance information, and scan details; include any required authorization information and patient demographics, then fax to the provided MRI/CT Fax number.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
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