Provider Demographics
NPI:1174674048
Name:ADVANCED HEALTHCARE RESOURCES INC
Entity Type:Organization
Organization Name:ADVANCED HEALTHCARE RESOURCES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:STACHOWIAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-483-3980
Mailing Address - Street 1:801 PHOENIX LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-2363
Mailing Address - Country:US
Mailing Address - Phone:630-483-3980
Mailing Address - Fax:630-483-3986
Practice Address - Street 1:4212 N 16TH ST
Practice Address - Street 2:ATTN CT SCANNER
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5319
Practice Address - Country:US
Practice Address - Phone:602-263-1626
Practice Address - Fax:602-263-1627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed TomographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ144866Medicaid
AZAZ0813860OtherAZ BCBS PROV ID
AZ144866Medicaid