Basic Information
| Provider Information | |||||||||
| NPI: | 1710360706 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED DIAGNOSTIC IMAGING PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3024 BUSINESS PARK CIR | ||||||||
| Address2: | |||||||||
| City: | GOODLETTSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370723132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158516033 | ||||||||
| FaxNumber: | 6158512018 | ||||||||
| Practice Location | |||||||||
| Address1: | 980 PROFESSIONAL PARK DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370405251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9319051001 | ||||||||
| FaxNumber: | 9319050410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2015 | ||||||||
| LastUpdateDate: | 07/08/2015 | ||||||||
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| AuthorizedOfficialLastName: | CALENDINE | ||||||||
| AuthorizedOfficialFirstName: | CHAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6158516033 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 335E00000X | Y | Suppliers | Prosthetic/Orthotic Supplier |
No ID Information.