Provider Demographics
NPI:1831155571
Name:ADVANCED HEALTHCARE DIAGNOSTIC SERVICES, LLC
Entity type:Organization
Organization Name:ADVANCED HEALTHCARE DIAGNOSTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARDA
Authorized Official - Suffix:
Authorized Official - Credentials:CPA,CMA
Authorized Official - Phone:573-778-0020
Mailing Address - Street 1:4061 HIGHWAY PP
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901
Mailing Address - Country:US
Mailing Address - Phone:573-778-0020
Mailing Address - Fax:573-778-1647
Practice Address - Street 1:2002 KANELL BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-4045
Practice Address - Country:US
Practice Address - Phone:573-785-4017
Practice Address - Fax:573-778-9132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology