Provider Demographics
NPI:1134152556
Name:ADVANCED MOBILE DIAGNOSTICS, INC.
Entity type:Organization
Organization Name:ADVANCED MOBILE DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHIOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-495-0240
Mailing Address - Street 1:7725 N KNOXVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-2079
Mailing Address - Country:US
Mailing Address - Phone:309-495-0240
Mailing Address - Fax:309-689-9035
Practice Address - Street 1:7725 N KNOXVILLE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-2079
Practice Address - Country:US
Practice Address - Phone:309-495-0003
Practice Address - Fax:309-495-0060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360520632Medicaid
IL036098202-1Medicaid
IL7215166OtherCHIOU BCBS
ILK18084OtherCHIOU PIN
ILP00310240OtherCHIOU RAILROAD MC
IL036095602-1Medicaid
IL7200497OtherANDERSON BCBS
ILP0030411OtherANDERSON RR MC
ILK18084OtherCHIOU PIN
IL036098202-1Medicaid
ILL96864OtherDEBORD PIN
ILP00310240OtherCHIOU RAILROAD MC
IL0360520632Medicaid
IL036098202-1Medicaid
IL036095602-1Medicaid