1851363972 NPI number — ADVANCED IMAGING LLC

Table of content: (NPI 1851363972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851363972 NPI number — ADVANCED IMAGING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED IMAGING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALBUQUERQUE IMAGING CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851363972
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46206-3202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-468-9497
Provider Business Mailing Address Fax Number:
855-630-1301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 LOMAS BLVD NE
Provider Second Line Business Practice Location Address:
4 WOODWARD CENTER
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87102-2568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-243-4401
Provider Business Practice Location Address Fax Number:
505-243-6474
Provider Enumeration Date:
02/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
POTTS
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
AOTHORIZED OFFICIAL
Authorized Official Telephone Number:
505-243-4401

Provider Taxonomy Codes

  • Taxonomy code: 2085B0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000L0634 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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