Provider Demographics
NPI:1912919903
Name:ADVANCED RADIOLOGY SERVICES, INC.
Entity Type:Organization
Organization Name:ADVANCED RADIOLOGY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-465-0593
Mailing Address - Street 1:30 GREENHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-4809
Mailing Address - Country:US
Mailing Address - Phone:727-480-3875
Mailing Address - Fax:
Practice Address - Street 1:30 GREENHAVEN CT
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-4809
Practice Address - Country:US
Practice Address - Phone:727-480-3875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL510020800Medicaid
FL630001656OtherPALMETTO GBA
FLW9933OtherBLUE CROSS
FL1600496EVCOtherEVERCARE
FLW9933OtherBLUE CROSS
FL=========OtherHUMANA/ MILITARY/ TRICARE
FL=========OtherAETNA
FLW9933Medicare ID - Type Unspecified