Provider Demographics
NPI:1710590492
Name:ADVANCED SCREENING LLC
Entity Type:Organization
Organization Name:ADVANCED SCREENING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:RUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-577-1102
Mailing Address - Street 1:8185 TEWKSBERRY PL
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-9626
Mailing Address - Country:US
Mailing Address - Phone:810-577-1102
Mailing Address - Fax:
Practice Address - Street 1:8401 HOLLY RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1812
Practice Address - Country:US
Practice Address - Phone:800-541-8810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology