Provider Demographics
NPI:1326374729
Name:ADVANTAGE IMAGING, LLC
Entity Type:Organization
Organization Name:ADVANTAGE IMAGING, LLC
Other - Org Name:ADVANTAGE DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-292-9998
Mailing Address - Street 1:3733 PARK EAST DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4338
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6900 RIDGE RD @ DELIVERY DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5650
Practice Address - Country:US
Practice Address - Phone:440-843-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHID03503OtherMEDICARE PTAN