Provider Demographics
NPI:1477935427
Name:ADVANCED MAGNETIC RESONANCE IMAGING
Entity Type:Organization
Organization Name:ADVANCED MAGNETIC RESONANCE IMAGING
Other - Org Name:ADVANCED MOLECULAR IMAGING LLC MB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CORLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-798-9225
Mailing Address - Street 1:2051 W 25TH ST
Mailing Address - Street 2:STE. D
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6912
Mailing Address - Country:US
Mailing Address - Phone:928-726-0811
Mailing Address - Fax:928-726-0833
Practice Address - Street 1:2051 W 25TH ST
Practice Address - Street 2:STE. D
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6912
Practice Address - Country:US
Practice Address - Phone:928-726-0811
Practice Address - Fax:928-726-0833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-26
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile