Provider Demographics
NPI:1851363972
Name:ADVANCED IMAGING LLC
Entity Type:Organization
Organization Name:ADVANCED IMAGING LLC
Other - Org Name:ALBUQUERQUE IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AOTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-243-4401
Mailing Address - Street 1:PO BOX 3202
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-3202
Mailing Address - Country:US
Mailing Address - Phone:844-468-9497
Mailing Address - Fax:855-630-1301
Practice Address - Street 1:700 LOMAS BLVD NE
Practice Address - Street 2:4 WOODWARD CENTER
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2568
Practice Address - Country:US
Practice Address - Phone:505-243-4401
Practice Address - Fax:505-243-6474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000L0634Medicaid
NM800521126Medicare PIN