Provider Demographics
NPI:1841399565
Name:ADVANCED DIAGNOSTIC IMAGING
Entity Type:Organization
Organization Name:ADVANCED DIAGNOSTIC IMAGING
Other - Org Name:MIDWEST ULTRASOUND CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NEGUSSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASEFFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-236-8406
Mailing Address - Street 1:PO BOX 5815
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-0815
Mailing Address - Country:US
Mailing Address - Phone:937-236-8406
Mailing Address - Fax:937-236-8408
Practice Address - Street 1:5300 BRANDT PIKE STE B
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-6114
Practice Address - Country:US
Practice Address - Phone:937-236-8406
Practice Address - Fax:937-236-8408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHID00361Medicare PIN