MEDICARE: ADVANCED DIAGNOSTICS NETWORK INC.

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	305R00000X	Preferred Provider Organization

General Provider Information

NPI Number	:	1508057662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED DIAGNOSTICS NETWORK INC.

Provider Business Mailing Address
First Line	:	13260 N 94TH DR STE 203
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85381-4240
Country	:	US
Telephone Number	:	623-876-1860
Fax Number	:

Provider Business Practice Location Address
First Line	:	13260 N 94TH DR STE 203
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85381-4240
Country	:	US
Telephone Number	:	623-876-1860
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KURT A. GRUTSCH
Credential	:
Telephone Number	:	623-876-1860

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	08/05/2007

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