Provider Demographics
NPI:1184884496
Name:ADVANCED IMAGING SERVICES, INC
Entity type:Organization
Organization Name:ADVANCED IMAGING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:G
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-684-0409
Mailing Address - Street 1:PO BOX 380552
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78268-7552
Mailing Address - Country:US
Mailing Address - Phone:210-684-0409
Mailing Address - Fax:210-684-0260
Practice Address - Street 1:5501 GRISSOM RD STE 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-3035
Practice Address - Country:US
Practice Address - Phone:210-684-0409
Practice Address - Fax:210-684-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0881807-01Medicaid
TX0879967-01Medicaid
TXFTA018Medicare PIN