1023189560 NPI number — ADVANCED RADIOLOGY HEALTHCARE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023189560 NPI number — ADVANCED RADIOLOGY HEALTHCARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED RADIOLOGY HEALTHCARE, 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:
Provider Other Organization Name Type Code:
6
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:
1023189560
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2270 S RIDGEVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YUMA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85364-8875
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-344-5006
Provider Business Mailing Address Fax Number:
928-317-9344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3885 COCHRAN ST STE J
Provider Second Line Business Practice Location Address:
PMB 347
Provider Business Practice Location Address City Name:
SIMI VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93063-2367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-307-8553
Provider Business Practice Location Address Fax Number:
805-583-1729
Provider Enumeration Date:
11/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STUDNER
Authorized Official First Name:
SANDY
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING ADMINISTRATOR
Authorized Official Telephone Number:
877-307-8553

Provider Taxonomy Codes

  • Taxonomy code: 2471M1202X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 087700 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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