Provider Demographics
NPI:1568621175
Name:ADVANCED RADIOLOGY OF JEFFERSON CITY, LLC
Entity Type:Organization
Organization Name:ADVANCED RADIOLOGY OF JEFFERSON CITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-442-1788
Mailing Address - Street 1:3218 W EDGEWOOD DR STE 200
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-6951
Mailing Address - Country:US
Mailing Address - Phone:573-635-6262
Mailing Address - Fax:573-635-9786
Practice Address - Street 1:3218 W EDGEWOOD DR STE 200
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-6951
Practice Address - Country:US
Practice Address - Phone:573-635-6262
Practice Address - Fax:573-635-9786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty