Provider Demographics
NPI:1154347326
Name:ADVANCED DIAGNOSTIC IMAGING SERVICES,INC.
Entity type:Organization
Organization Name:ADVANCED DIAGNOSTIC IMAGING SERVICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRAZIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-741-9045
Mailing Address - Street 1:137 S ASPEN CT STE A
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5175
Mailing Address - Country:US
Mailing Address - Phone:559-741-9045
Mailing Address - Fax:559-741-9050
Practice Address - Street 1:137 S ASPEN CT STE A
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5175
Practice Address - Country:US
Practice Address - Phone:559-741-9045
Practice Address - Fax:559-741-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ14250ZMedicare ID - Type Unspecified