1740283324 NPI number — ADVANCED RADIOLOGY SERVICES, P.C.

Table of content: (NPI 1740283324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740283324 NPI number — ADVANCED RADIOLOGY SERVICES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED RADIOLOGY SERVICES, P.C.
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:
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:
1740283324
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3264 N EVERGREEN DR NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49525-9746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-363-7272
Provider Business Mailing Address Fax Number:
616-363-7290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3264 N EVERGREEN DR NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49525-9746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-363-7272
Provider Business Practice Location Address Fax Number:
616-363-7290
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WESTPHAL
Authorized Official First Name:
RITA
Authorized Official Middle Name:
Authorized Official Title or Position:
CAO
Authorized Official Telephone Number:
616-363-7339

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  502389 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CN1920 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P63018 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0N99420 . This is a "MEDICARE NP GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0N78710 . This is a "MEDICARE PA GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 500D114350 . This is a "BLUE CROSS BLUE SHIELD NP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: CN1919 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 300D110870 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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