Healthcare Provider Details

I. General information

NPI: 1629169602
Provider Name (Legal Business Name): ADVANCED MEDICAL IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 COLLEGE DR
ROCK SPRINGS WY
82901-5868
US

IV. Provider business mailing address

PO BOX 912853
DENVER CO
80291-2853
US

V. Phone/Fax

Practice location:
  • Phone: 786-621-3900
  • Fax:
Mailing address:
  • Phone: 786-621-3900
  • Fax: 405-948-6507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FREDERICK L MATTI
Title or Position: PRESIDENT
Credential: MD
Phone: 307-352-8384