Provider Demographics
NPI:1629169602
Name:ADVANCED MEDICAL IMAGING LLC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:MATTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-352-8384
Mailing Address - Street 1:PO BOX 912853
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-2853
Mailing Address - Country:US
Mailing Address - Phone:786-621-3900
Mailing Address - Fax:405-948-6507
Practice Address - Street 1:1200 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5868
Practice Address - Country:US
Practice Address - Phone:786-621-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
06012001OtherBCBS OF WY
WY123400500Medicaid
612454200OtherDEPT OF LABOR
06012001OtherBCBS OF WY
WY20998Medicare PIN
DF2271Medicare PIN