Provider Demographics
NPI:1679861058
Name:ADVANCE IMAGING PSC
Entity Type:Organization
Organization Name:ADVANCE IMAGING PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLODZIEJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-620-8740
Mailing Address - Street 1:PO BOX 364443
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-274-1672
Mailing Address - Fax:787-200-4318
Practice Address - Street 1:CENTRO CARDIOVASCULAR DE PR Y DEL CARIBE
Practice Address - Street 2:AVE AMERICO MIRANDA ENTRADA PRINCIPAL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-274-1672
Practice Address - Fax:787-200-4318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
87835Medicare UPIN