Healthcare Provider Details
I. General information
NPI: 1558814632
Provider Name (Legal Business Name): ADVANCED DIAGNOSTIC IMAGING, PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/26/2016
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
693 PRESIDENT PL STE 103
SMYRNA TN
37167-8601
US
IV. Provider business mailing address
3024 BUSINESS PARK CIR
GOODLETTSVILLE TN
37072-3132
US
V. Phone/Fax
- Phone: 615-220-8788
- Fax: 615-220-8688
- Phone: 615-239-2018
- Fax: 615-851-2018
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 332B00000X |
| Taxonomy | Durable Medical Equipment & Medical Supplies |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 332BC3200X |
| Taxonomy | Customized Equipment (DME) |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 335E00000X |
| Taxonomy | Prosthetic/Orthotic Supplier |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
CHAD
L
CALENDINE
Title or Position: CEO
Credential: MD
Phone: 615-356-3999