Provider Demographics
NPI:1568449932
Name:ADVANCED MEDICAL IMAGING CENTER, INC.
Entity Type:Organization
Organization Name:ADVANCED MEDICAL IMAGING CENTER, INC.
Other - Org Name:ADVANCED MEDICAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-675-2439
Mailing Address - Street 1:PO BOX 292921
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33687-2921
Mailing Address - Country:US
Mailing Address - Phone:813-675-2498
Mailing Address - Fax:813-971-0818
Practice Address - Street 1:525 S LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36104-4611
Practice Address - Country:US
Practice Address - Phone:334-262-7226
Practice Address - Fax:334-261-2641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10857261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology