Provider Demographics
NPI:1174654172
Name:ADVANCED RADIOLOGY LLC
Entity Type:Organization
Organization Name:ADVANCED RADIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:GALIBER
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS, RVT
Authorized Official - Phone:340-772-7423
Mailing Address - Street 1:6002 DIAMOND RUBY STE 3
Mailing Address - Street 2:PMB 128
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-5226
Mailing Address - Country:US
Mailing Address - Phone:340-772-7423
Mailing Address - Fax:340-719-2300
Practice Address - Street 1:4007 DIAMOND RUBY
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4421
Practice Address - Country:US
Practice Address - Phone:340-772-7423
Practice Address - Fax:340-719-2300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI6-4335Medicare ID - Type UnspecifiedIDTF