Provider Demographics
NPI:1174006217
Name:ADVANCED IMAGING SERVICES, LLC
Entity Type:Organization
Organization Name:ADVANCED IMAGING SERVICES, LLC
Other - Org Name:ADVANCED IMAGING SERVICES SOUTH SHORE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUDHEER
Authorized Official - Middle Name:
Authorized Official - Last Name:PARUCHURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-622-7622
Mailing Address - Street 1:PO BOX 7230
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-7230
Mailing Address - Country:US
Mailing Address - Phone:773-356-5000
Mailing Address - Fax:
Practice Address - Street 1:8012 S CRANDON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-1124
Practice Address - Country:US
Practice Address - Phone:773-356-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED IMAGING SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-14
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid