Provider Demographics
NPI:1851765028
Name:ADVANCED DIAGNOSTIC MEDICAL IMAGING, INC.
Entity Type:Organization
Organization Name:ADVANCED DIAGNOSTIC MEDICAL IMAGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:DENNISON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:813-876-7600
Mailing Address - Street 1:1921 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6509
Mailing Address - Country:US
Mailing Address - Phone:813-876-7600
Mailing Address - Fax:813-876-7675
Practice Address - Street 1:1921 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6509
Practice Address - Country:US
Practice Address - Phone:813-876-7600
Practice Address - Fax:813-876-7675
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED PAIN CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty