Provider Demographics
NPI:1023016532
Name:ADVANCED IMAGING ASSOCIATES PSC
Entity Type:Organization
Organization Name:ADVANCED IMAGING ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-789-3511
Mailing Address - Street 1:PO BOX 633638
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-3638
Mailing Address - Country:US
Mailing Address - Phone:866-287-0542
Mailing Address - Fax:
Practice Address - Street 1:625 JAMES TRIMBLE BLVD
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1055
Practice Address - Country:US
Practice Address - Phone:606-789-3511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65938193Medicaid
DA2906OtherRAILROAD MEDICARE
KY000000244294OtherBC/BS GROUP PIN NUMBER
KY000000244294OtherBC/BS GROUP PIN NUMBER