Basic Information
| Provider Information | |||||||||
| NPI: | 1174604334 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED RADIOLOGIC PHYSICIANS, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | X-RAY ASSOCIATES, INC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3455 MILL RUN DR. | ||||||||
| Address2: | SUITE 450 | ||||||||
| City: | HILLIARD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430269083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147712229 | ||||||||
| FaxNumber: | 6147712248 | ||||||||
| Practice Location | |||||||||
| Address1: | 950 W. WOOSTER ST. | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434022603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193548960 | ||||||||
| FaxNumber: | 4193548957 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 05/13/2009 | ||||||||
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| AuthorizedOfficialLastName: | GUSTINE | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4193548960 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 2117604 | 05 | OH | MEDICAID | 2115688 | 05 | OH | MEDICAID | 2522336 | 05 | OH | MEDICAID | 0200900 | 05 | OH | MEDICAID | 2190838 | 05 | OH | MEDICAID | 9123890 00 | 05 | FL | MEDICAID | 8759884 | 05 | OH | MEDICAID |