Provider Demographics
NPI:1780636928
Name:ADVANCED MEDICAL SOLUTIONS, LLC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL SOLUTIONS, LLC
Other - Org Name:MARYLAND OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:EDMOND
Authorized Official - Last Name:GAETJENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-960-4645
Mailing Address - Street 1:14201 LAUREL PARK DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5203
Mailing Address - Country:US
Mailing Address - Phone:301-960-4645
Mailing Address - Fax:301-317-5065
Practice Address - Street 1:8200 PROFESSIONAL PL
Practice Address - Street 2:SUITE 115
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-2212
Practice Address - Country:US
Practice Address - Phone:301-918-0072
Practice Address - Fax:301-918-1778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2007-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM232261QM1200X
MD261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDFDX002Medicare ID - Type UnspecifiedPRINCE GEORGES COUNTY
MDFMX018Medicare PIN