Provider Demographics
NPI:1073592473
Name:ADVANCED IMAGING S.C.
Entity Type:Organization
Organization Name:ADVANCED IMAGING S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:G
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-746-9729
Mailing Address - Street 1:228 S 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-1000
Mailing Address - Country:US
Mailing Address - Phone:920-746-9729
Mailing Address - Fax:920-746-9881
Practice Address - Street 1:228 S 18TH AVE
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-1000
Practice Address - Country:US
Practice Address - Phone:920-746-9729
Practice Address - Fax:920-746-9881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32877400Medicaid
WI32877400Medicaid