MEDICARE: ONSITE ADVANCED IMAGING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0208X	Mobile Radiology Clinic/Center
2	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

General Provider Information

NPI Number	:	1285931881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONSITE ADVANCED IMAGING LLC

Provider Business Mailing Address
First Line	:	PO BOX 61328
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31420-1328
Country	:	US
Telephone Number	:	912-228-5469
Fax Number	:	866-283-7925

Provider Business Practice Location Address
First Line	:	11551 SOUTHERN BLVD
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-4254
Country	:	US
Telephone Number	:	561-228-4553
Fax Number	:	866-283-7925

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	TIMOTHY J SAK
Credential	:
Telephone Number	:	561-228-4553

Provider Enumeration Date	:	02/16/2011
Last Update Date	:	02/16/2011

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