Provider Demographics
NPI:1740283324
Name:ADVANCED RADIOLOGY SERVICES, P.C.
Entity type:Organization
Organization Name:ADVANCED RADIOLOGY SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTPHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-363-7339
Mailing Address - Street 1:3264 N EVERGREEN DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9746
Mailing Address - Country:US
Mailing Address - Phone:616-363-7272
Mailing Address - Fax:616-363-7290
Practice Address - Street 1:3264 N EVERGREEN DR NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9746
Practice Address - Country:US
Practice Address - Phone:616-363-7272
Practice Address - Fax:616-363-7290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5023892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICN1920OtherRAILROAD MEDICARE
MIP63018OtherBLUE CARE NETWORK
MI0N99420OtherMEDICARE NP GROUP
MI0N78710OtherMEDICARE PA GROUP
MI500D114350OtherBLUE CROSS BLUE SHIELD NP
MICN1919OtherRAILROAD MEDICARE
MI300D110870OtherBLUE CROSS BLUE SHIELD
MIP63018OtherBLUE CARE NETWORK