Organization Name: | ADVANCED DIAGNOSTIC CENTER LLC |
NPI Number: | 1033418447 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LISA KAY PAGE (CREDENTIALING MANAGER) |
Mailing Address: | 205 Hospital Dr Suite C Mc Kenzie |
State: | TN US |
Postal Code: | 382011649 |
Phone Number: | 7313527907 |
Fax Number: | 7313524459 |
NPI Enumeration Date: | 03/24/2011 |
NPI Last Update Date: | 03/29/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Radiology |
Taxonomy Definition: |