Provider Demographics
NPI:1073563854
Name:ADVANCED RADIOLOGY HEALTHCARE LLC
Entity Type:Organization
Organization Name:ADVANCED RADIOLOGY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:STUDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-307-8553
Mailing Address - Street 1:PO BOX 17049
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85011-0049
Mailing Address - Country:US
Mailing Address - Phone:877-307-8553
Mailing Address - Fax:805-583-1729
Practice Address - Street 1:2270 S RIDGEVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364
Practice Address - Country:US
Practice Address - Phone:877-307-8553
Practice Address - Fax:805-583-1729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ087700Medicaid
AZAZ0368950OtherBLUE CROSS
AZAZ0368950OtherBLUE CROSS