Provider Demographics
NPI:1972522126
Name:ADVANCED DIAGNOSTIC IMAGING, PC
Entity Type:Organization
Organization Name:ADVANCED DIAGNOSTIC IMAGING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BIES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:124-799-5008
Mailing Address - Street 1:1200 PROFESSIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-8002
Mailing Address - Country:US
Mailing Address - Phone:812-479-9500
Mailing Address - Fax:812-479-9500
Practice Address - Street 1:1200 PROFESSIONAL BLVD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-8002
Practice Address - Country:US
Practice Address - Phone:812-479-9500
Practice Address - Fax:812-479-9500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200181650AMedicaid
IN639970Medicare ID - Type Unspecified