Provider Demographics
NPI:1508057662
Name:ADVANCED DIAGNOSTICS NETWORK INC.
Entity Type:Organization
Organization Name:ADVANCED DIAGNOSTICS NETWORK INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRUTSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-876-1860
Mailing Address - Street 1:13260 N 94TH DR STE 203
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4240
Mailing Address - Country:US
Mailing Address - Phone:623-876-1860
Mailing Address - Fax:
Practice Address - Street 1:13260 N 94TH DR STE 203
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4240
Practice Address - Country:US
Practice Address - Phone:623-876-1860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization